Article ; Online: Sex and race differences in the performance of the European Society of Cardiology 0/1-h algorithm with high-sensitivity troponin T.
2023 Volume 47, Issue 2, Page(s) e24199
Abstract: ... of Cardiology (ESC) 0/1-h algorithm in sex and race subgroups of US Emergency Department (ED) patients is ... and 1-h hs-cTnT measures from eight US EDs (1/2017 to 9/2018) were stratified into rule-out ... the hs-cTnT ESC 0/1-h algorithm may not be safe for use in US EDs. Trial Registration: High-Sensitivity ...
| Abstract | The diagnostic performance of the high-sensitivity troponin T (hs-cTnT) European Society of Cardiology (ESC) 0/1-h algorithm in sex and race subgroups of US Emergency Department (ED) patients is unclear. A pre-planned subgroup analysis of the STOP-CP cohort study was conducted. Participants with 0- and 1-h hs-cTnT measures from eight US EDs (1/2017 to 9/2018) were stratified into rule-out, observation, and rule-in zones using the hs-cTnT ESC 0/1 algorithm. The primary outcome was adjudicated 30-day cardiac death or MI. The proportion with the primary outcome in each zone was compared between subgroups with Fisher's exact tests. The negative predictive value (NPV) of the ESC 0/1 rule-out zone for 30-day CDMI was calculated and compared between subgroups using Fisher's exact tests. Of the 1422 patients enrolled, 54.2% (770/1422) were male and 58.1% (826/1422) white with a mean age of 57.6 ± 12.8 years. At 30 days, cardiac death or myocardial infarction (MI) occurred in 12.9% (183/1422) of participants. Among patients stratified to the rule-out zone, 30-day cardiac death or MI occurred in 1.1% (5/436) of women versus 2.1% (8/436) of men (p = .40) and 1.2% (4/331) of non-white patients versus 1.8% (9/490) of white patients (p = .58). The NPV for 30-day cardiac death or MI was similar among women versus men (98.9% [95% confidence interval, CI: 97.3-99.6] vs. 97.9% [95% CI: 95.9-99.1]; p = .40) and among white versus non-white patients (98.8% [95% CI: 96.9-99.7] vs. 98.2% [95% CI: 96.5-99.2]; p = .39). NPVs <99% in each subgroup suggest the hs-cTnT ESC 0/1-h algorithm may not be safe for use in US EDs. Trial Registration: High-Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification (STOP-CP; ClinicalTrials.gov: NCT02984436; https://clinicaltrials.gov/ct2/show/NCT02984436). |
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| MeSH term(s) | Humans ; Male ; Female ; Adult ; Middle Aged ; Aged ; Troponin T ; Cohort Studies ; Race Factors ; Prospective Studies ; Myocardial Infarction/diagnosis ; Cardiology ; Algorithms ; Death ; Biomarkers |
| Chemical Substances | Troponin T ; Biomarkers |
| Language | English |
| Publishing date | 2023-12-13 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 391935-3 |
| ISSN | 1932-8737 ; 0160-9289 |
| ISSN (online) | 1932-8737 |
| ISSN | 0160-9289 |
| DOI | 10.1002/clc.24199 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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