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Impact of switching high-sensitivity cardiac troponin assays on risk stratification in suspected acute coronary syndrome
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DOI：10.1093/ehjacc/zuag042.png)
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Abstract
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Aims Cardiac troponin is central to risk stratification in patients with suspected acute coronary syndrome. High-sensitivity assays measuring cardiac troponin (hs-cTn) I or T are recommended by international guidelines. However, diagnostic thresholds for these assays are derived from different populations. We aimed to evaluate whether the change in assay influenced risk stratification. Methods and results This is a secondary analysis of the TWITCH-ED study enrolling 25 849 patients with suspected acute coronary syndrome between October 2020 and October 2022. In October 2021, sites changed from an hs-cTnI to an hs-cTnT assay. Study outcomes included discharge from the Emergency Department following a single cardiac troponin measurement, a composite outcome of subsequent myocardial infarction, heart failure hospitalization, or cardiovascular death at 1 year, and all-cause death at 1 year. Patients were stratified as low-risk at presentation using established thresholds. Higher proportions of patients were identified as low-risk (57.3% vs. 17.6%) and discharged following a single troponin measurement (47% vs. 30%) using the hs-cTnI assay, compared to the hs-cTnT assay (P < 0.001 for both). Those identified as low-risk with the hs-cTnT assay were younger (median 52 [inter-quartile range 40-62] vs. 41 [32-51] years) with fewer comorbidities, and had lower rates for the composite outcome (0.8% vs. 0.2%) and all-cause death (2.0% vs. 0.3%) (P < 0.001 for both) at 1 year. Conclusion Risk stratification thresholds for hs-cTnI and hs-cTnT assays do not provide equivalent performance. The hs-cTnT assay and threshold identified fewer low-risk patients suitable for discharge, with fewer subsequent cardiovascular events at 1 year.
Keywords:
Myocardial infarction
Cardiac troponin
Risk stratification
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