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Derivation and Validation of ESC-0/1-h Algorithm for High-Sensitivity Troponin T and I in Cancer Patients
Paolo Bima1, Pedro Lopez-Ayala2, Luca Koechlin3
1Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network, Rome, Italy; Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy.
Insights
New European Society of Cardiology (ESC) 0/1-hour high-sensitivity cardiac troponin (hs-cTnT/I) algorithm cutoffs optimized for cancer patients improve non-ST-elevation myocardial infarction diagnosis efficacy and safety.
Area of Science:
- Cardiology
- Oncology
- Biomarker Diagnostics
Background:
- Diagnostic performance of high-sensitivity cardiac troponin T/I (hs-cTnT/I) and European Society of Cardiology (ESC) 0/1-h algorithms for non-ST-elevation myocardial infarction (NSTEMI) is reduced in cancer patients.
- Cancer patients present unique challenges for NSTEMI diagnosis due to potential biomarker alterations.
Purpose of the Study:
- To derive and validate novel hs-cTnT/I cutoffs within the ESC 0/1-h algorithm framework, specifically tailored for patients with active or past cancer.
- To enhance the diagnostic accuracy and clinical utility of hs-cTnT/I testing in the cancer population for NSTEMI detection.
Main Methods:
- International multicenter study analyzing patients with suspected NSTEMI.
- Central adjudication of final diagnoses by two independent cardiologists based on the fourth universal definition of myocardial infarction.
- External validation in two independent cohorts to confirm the generalizability of the derived cutoffs.
Main Results:
- Cancer-optimized ESC 0/1-h hs-cTnT cutoffs significantly increased diagnostic efficacy from 58.6% to 68.0% (P < 0.001), maintaining high sensitivity and specificity.
- Cancer-optimized ESC 0/1-h hs-cTnI-Architect cutoffs improved efficacy from 59.3% to 78.9% (P < 0.001), with preserved sensitivity and specificity.
- Findings were robustly validated in internal and external patient cohorts.
Conclusions:
- The developed cancer-optimized ESC 0/1-h hs-cTnT/I algorithm cutoffs enhance diagnostic efficacy for NSTEMI in cancer patients.
- These optimized cutoffs maintain high safety profiles, ensuring reliable rule-out and rule-in of myocardial infarction.
Background:
The diagnostic performance of high-sensitivity cardiac troponin T/I (hs-cTnT/I) and the efficacy of the European Society of Cardiology (ESC) 0/1-h hs-cTnT/I algorithms for the early diagnosis of non-ST-elevation myocardial infarction are lower in cancer patients.
Objectives:
The authors aimed to derive new cutoffs for ESC 0/1-h hs-cTnT/I algorithms optimized for use in patients with active or past cancer.
Methods:
Patients presenting with suspected non-ST-elevation myocardial infarction to the emergency department enrolled in an international multicenter study were analyzed. Final diagnoses were centrally adjudicated by 2 independent cardiologists according to the fourth universal definition of myocardial infarction. External validation was performed in 2 independent cohorts.
Results:
Among 541 eligible cancer patients, cancer-optimized ESC 0/1-h hs-cTnT cutoffs, <8 ng/L at presentation (if chest pain onset >3 hours) or <14 ng/L if 0/1 h-delta is <3 ng/L for rule-out and ≥54 ng/L or 0/1-h delta ≥4 ng/L for rule-in, increased the efficacy vs the current cutoffs from 58.6% (95% CI: 54.4-62.7) to 68.0% (95% CI: 64.0-71.8; P < 0.001). Sensitivity and specificity remained high and comparable. Similarly, among 516 eligible patients, cancer-optimized ESC 0/1-h hs-cTnI-Architect cutoffs, <7 ng/L at presentation (if chest pain onset >3 hours) or <10 ng/L if 0/1-h delta is <3 ng/L for rule-out and ≥61 ng/L or 0/1-h delta ≥5 ng/L for rule-in, increased the efficacy vs the current cutoffs from 59.3% (95% CI: 55.0-63.5) to 78.9% (95% CI: 75.2-82.2; P < 0.001). Sensitivity and specificity again remained high and comparable. Findings were confirmed in internal and external validation cohorts (n = 130 and n = 195 patients, respectively).
Conclusions:
Cancer-optimized ESC 0/1-h hs-cTnT/I algorithm cutoffs increased efficacy maintaining high safety.
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