Diagnostic Performance of Novel Troponin Algorithms for the Rule-Out of Non-ST-Elevation Acute Coronary Syndrome

Tjora, Hilde L, Steiro, Ole-Thomas, Langorgen, Jorund, Bjorneklett, Rune O, Skadberg, Oyvind, Bonarjee, Vernon VS, Mjelva, Oistein R, Collinson, Paul ORCID: 0000-0002-7000-5996, Omland, Torbjorn, Vikenes, Kjell
et al (show 1 more authors) (2022) Diagnostic Performance of Novel Troponin Algorithms for the Rule-Out of Non-ST-Elevation Acute Coronary Syndrome. CLINICAL CHEMISTRY, 68 (2). pp. 291-302.

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<h4>Background</h4>The European Society of Cardiology (ESC) rule-out algorithms use cutoffs optimized for exclusion of non-ST elevation myocardial infarction (NSTEMI). We investigated these and several novel algorithms for the rule-out of non-ST elevation acute coronary syndrome (NSTE-ACS) including less urgent coronary ischemia.<h4>Method</h4>A total of 1504 unselected patients with suspected NSTE-ACS were included and divided into a derivation cohort (n = 988) and validation cohort (n = 516). The primary endpoint was the diagnostic performance to rule-out NSTEMI and unstable angina pectoris during index hospitalization. The secondary endpoint was combined MI, all-cause mortality (within 30 days) and urgent (24 h) revascularization. The ESC algorithms for high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) were compared to different novel low-baseline (limit of detection), low-delta (based on the assay analytical and biological variation), and 0-1-h and 0-3-h algorithms.<h4>Results</h4>The prevalence of NSTE-ACS was 24.8%, 60.0% had noncardiac chest pain, and 15.2% other diseases. The 0-1/0-3-h algorithms had superior clinical sensitivity for the primary endpoint compared to the ESC algorithm (validation cohort); hs-cTnT: 95% vs 63%, and hs-cTnI: 87% vs 64%, respectively. Regarding the secondary endpoint, the algorithms had similar clinical sensitivity (100% vs 94%-96%) but lower clinical specificity (41%-19%) compared to the ESC algorithms (77%-74%). The rule-out rates decreased by a factor of 2-4.<h4>Conclusion</h4>Low concentration/low-delta troponin algorithms improve the clinical sensitivity for a combined endpoint of NSTEMI and unstable angina pectoris, with the cost of a substantial reduction in total rule-out rate. There was no clear benefit compared to ESC for diagnosing high-risk events.

Item Type: Article
Uncontrolled Keywords: troponin, acute coronary syndrome, clinical investigation, laboratory methods and tools
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 09 Nov 2022 10:37
Last Modified: 18 Jan 2023 19:43
DOI: 10.1093/clinchem/hvab225
Open Access URL: https://doi.org/10.1093/clinchem/hvab225
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3166089