Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St Suite 400, Boston, MA 02114, USA.
Heart and Vascular Center, Semmelweis University, 9-11 Gaál József Street, Budapest 1122, Hungary.
Eur Heart J Acute Cardiovasc Care. 2024 Feb 9;13(1):15-23. doi: 10.1093/ehjacc/zuad146.
Quality-of-care and safety of patients with suspected acute coronary syndrome (ACS) would benefit if management was independent of which high-sensitivity cardiac troponin (hs-cTn) assay was used for risk stratification. We aimed to determine the concordance of hs-cTn assays to risk-stratify patients with suspected ACS according to the European Society of Cardiology (ESC) 2020 Guidelines.
Blood samples were obtained at arrival and at 2 h from patients with suspected ACS using four hs-cTn assays. The patients were classified into rule-out/observe/rule-in strata based on the ESC 2020 Guidelines. Concordance was determined among the assays for rule-out/observe/rule-in strata. The prevalences of significant underlying disease (≥50% stenosis on coronary computed tomography or inducible myocardial ischaemia on stress testing) and adjudicated ACS, plus quality-of-care outcomes, were compared. Among 238 patients (52.7 ± 8.0 years; 40.3% female), the overall concordance across assays to classify patients into rule-out/observe/rule-in strata was 74.0% (176/238). Platforms significantly differed for rule-out (89.9 vs. 76.5 vs. 78.6 vs. 86.6%, P < 0.001) and observe strata (6.7 vs. 20.6 vs. 17.7 vs. 9.2%, P < 0.001), but not for rule-in strata (3.4 vs. 2.9 vs. 3.8 vs. 4.2%, P = 0.62). Among patients in ruled-out strata, 19.1-21.6% had significant underlying disease and 3.3-4.2% had ACS. The predicted disposition of patients and cost-of-care differed across the assays (all P < 0.001). When compared with observed strata, conventional troponin-based management and predicted quality-of-care outcomes significantly improved with hs-cTn-based strategies (direct discharge: 21.0 vs. 80.3-90.8%; cost-of-care: $3889 ± 4833 vs. $2578 ± 2896-2894 ± 4371, all P < 0.001).
Among individuals with suspected ACS, patient management may differ depending on which hs-cTn assay is utilized. More data are needed regarding the implications of inter-assay differences.
NCT01084239.
如果管理独立于用于风险分层的高敏心肌肌钙蛋白（hs-cTn）检测方法，则疑似急性冠状动脉综合征（ACS）患者的治疗质量和安全性将得到改善。本研究旨在根据 2020 年欧洲心脏病学会（ESC）指南确定 hs-cTn 检测方法在风险分层方面对疑似 ACS 患者的一致性。
使用四种 hs-cTn 检测方法在疑似 ACS 患者到达时和 2 小时时采集血样。根据 ESC 2020 指南，患者被分为排除/观察/确诊分层。确定了检测方法在排除/观察/确诊分层中的一致性。比较了有意义的基础疾病（冠状动脉计算机断层扫描≥50%狭窄或应激试验诱导性心肌缺血）和确定的 ACS 的发生率以及治疗质量结果。在 238 名患者（52.7±8.0 岁；40.3%为女性）中，检测方法在将患者分为排除/观察/确诊分层中的总体一致性为 74.0%（176/238）。平台在排除（89.9%比 76.5%比 78.6%比 86.6%，P<0.001）和观察（6.7%比 20.6%比 17.7%比 9.2%，P<0.001）分层方面差异显著，但在确诊分层方面差异不显著（3.4%比 2.9%比 3.8%比 4.2%，P=0.62）。在排除分层的患者中，19.1%-21.6%有明显的基础疾病，3.3%-4.2%有 ACS。不同检测方法之间患者的预测处理方式和治疗质量结果存在差异（均 P<0.001）。与观察分层相比，基于 hs-cTn 的策略显著改善了传统肌钙蛋白管理和预测的治疗质量结果（直接出院：21.0%比 80.3%-90.8%；治疗费用：$3889±4833 比 $2578±2896-2894±4371，均 P<0.001）。
在疑似 ACS 患者中，患者的管理可能取决于使用的 hs-cTn 检测方法。需要更多关于检测方法差异影响的数据。
NCT01084239。
