Derivation and Validation of ESC-0/1-h Algorithm for High-Sensitivity Troponin T and I in Cancer Patients
Year: 2025
Type: article
Abstract: BACKGROUND: The diagnostic performance of high-sensitivity cardiac troponin T/I (hs-cTnT/I) and the efficacy of the European Society of Cardiology (ESC) 0/1-h hs-cTnT/I algorithms for the early diagnosis of non-ST-elevation myocardial infarction are lower in cancer patients. OBJECTIVES: The authors aimed to derive new cutoffs for ESC 0/1-h hs-cTnT/I algorithms optimized for use in patients with active or past cancer. METHODS: Patients presenting with suspected non-ST-elevation myocardial infarction to the emergency department enrolled in an international multicenter study were analyzed. Final diagnoses were centrally adjudicated by 2 independent cardiologists according to the fourth universal definition of myocardial infarction. External validation was performed in 2 independent cohorts. RESULTS: Among 541 eligible cancer patients, cancer-optimized ESC 0/1-h hs-cTnT cutoffs, <8 ng/L at presentation (if chest pain onset >3 hours) or <14 ng/L if 0/1 h-delta is <3 ng/L for rule-out and ≥54 ng/L or 0/1-h delta ≥4 ng/L for rule-in, increased the efficacy vs the current cutoffs from 58.6% (95% CI: 54.4-62.7) to 68.0% (95% CI: 64.0-71.8; P < 0.001). Sensitivity and specificity remained high and comparable. Similarly, among 516 eligible patients, cancer-optimized ESC 0/1-h hs-cTnI-Architect cutoffs, <7 ng/L at presentation (if chest pain onset >3 hours) or <10 ng/L if 0/1-h delta is <3 ng/L for rule-out and ≥61 ng/L or 0/1-h delta ≥5 ng/L for rule-in, increased the efficacy vs the current cutoffs from 59.3% (95% CI: 55.0-63.5) to 78.9% (95% CI: 75.2-82.2; P < 0.001). Sensitivity and specificity again remained high and comparable. Findings were confirmed in internal and external validation cohorts (n = 130 and n = 195 patients, respectively). CONCLUSIONS: Cancer-optimized ESC 0/1-h hs-cTnT/I algorithm cutoffs increased efficacy maintaining high safety.
Source: JACC Advances
Authors: Paolo Bima, Pedro Lopez-Ayala, Luca Koechlin, Fulvio Morello, Jasper Boeddinghaus, Mihaela Dimitrova, Carlos C. Spagnuolo, Emel Kaplan, Thomas Nestelberger, Jonas Glaeser, Karin Wildi, Jeanne du Fay de Lavallaz, Beata Morawiec, Oscar Miro, Gemma Martínez-Nadal, Francisco J. Martin-Sanchez, Michael Christ, Ksenija Slankamenac, Giulia Labarile, Bertil Lindahl, Evangelos Giannitsis, Enrico Lupia, Christian Mueller, Maria Rubini Gimenez, Bernhard Okamura, Tamar S. Muench-Gerber, Alessandra Sanzone, Tobias Zimmermann, Desiree Wussler, Joan Walter, Patrick Badertscher, Christian Puelacher, Dagmar Keller, Tobias Breidthardt, Eliska Potlukova, Damian Kawecki, Nicolas Geigy, Katharina Rentsch, Piotr Munzk, Gemma Martinez-Nadal, Esther Rodriguez Adrada, Eva Ganovská, Jiri Parenica, Arnold von Eckardstein, Isabel Campodarve, James McCord, Richard Nowak, Richard Body, Christopher R. deFilippi, Robert H. Christenson, Mauro Panteghini, Mario Plebani, Franck Verschuren, John French, Silvia Weiser, Tomas Jernberg, Aitor Alquézar-Arbé, Jordi Ordonez-Llanos
Institutions: University of Basel, University Hospital of Basel, University of Turin, University of Edinburgh, Medical University of Silesia, Hospital Clínic de Barcelona, Hospital Clínico San Carlos, Luzerner Kantonsspital, University Hospital Zurich, Uppsala University, University Hospital Heidelberg
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,936
OpenAlex ID: W4410609604