Performance of High-Sensitivity Troponin T Risk Stratification Strategies for 90-day Cardiac Death or Myocardial...

Area of Science:

• Cardiology
• Emergency Medicine
• Biomarker Research

Background:

• Established 30-day performance of European Society of Cardiology (ESC) 0/1-hour and "one-and-done" high-sensitivity troponin T (hs-cTnT) strategies.
• Limited understanding of the 90-day performance of these hs-cTnT strategies in a US population.
• Need to evaluate long-term outcomes beyond initial emergency department assessment.

Purpose of the Study:

• To assess the 90-day performance of ESC 0/1-hour and "one-and-done" hs-cTnT strategies.
• To evaluate the impact of incorporating the HEART score on these strategies.
• To determine the negative predictive value (NPV) and efficacy for identifying 90-day cardiac events.

Main Methods:

• Prospective, multisite US cohort study of adults presenting with chest pain.
• Utilized 0- and 1-hour hs-cTnT measurements for ESC 0/1-h algorithm classification.
• Defined "one-and-done" strategy by hs-cTnT below the limit of quantification at 0-h.
• Primary outcome: adjudicated 90-day cardiac death or myocardial infarction (MI).
• Calculated NPV and efficacy, with and without the HEART score.

Main Results:

• In 1462 patients, 14.0% experienced 90-day cardiac death or MI.
• The "one-and-done" strategy had 32.8% efficacy and 99.0% NPV.
• The ESC 0/1-h algorithm showed 57.8% efficacy and 98.3% NPV.
• Adding the HEART score decreased efficacy for both strategies but increased NPV.
• Combined HEART score and "one-and-done": 20.1% efficacy, 99.7% NPV.
• Combined HEART score and ESC 0/1-h: 30.8% efficacy, 99.3% NPV.

Conclusions:

• Both "one-and-done" and ESC 0/1-hour hs-cTnT strategies demonstrated modest 90-day performance.
• The strategies had a low rate of missed 90-day cardiac death or MI.
• Integrating the HEART score enhanced safety (higher NPV) at the cost of reduced efficacy (fewer patients ruled out).