Derivation and Validation of ESC-0/1-h Algorithm for High-Sensitivity Troponin T and I in Cancer Patients - Bima, P.; Lopez-Ayala, P.; Koechlin, L.; Morello, F.; Boeddinghaus, J.; Dimitrova, M.; Spagnuolo, C. C.; Kaplan, E.; Nestelberger, T.; Glaeser, J.; Wildi, K.; du Fay de Lavallaz, J.; et al. (JACC Adv, 2025)
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.
Keywords: journalArticle; Astra Zeneca, Bayer, Boehringer Ingelheim, BMS, Osler, Novartis, Roche, Siemens,; Bando d'Eccellenza 2023 to EL) and; Basel, the University Hospital of Basel, the Division of Internal Medicine, the; Boeddinghaus, and Mueller had full access to all the data in the study and take; Cardiorentis, and Sanofi and research grants from the Spanish Ministry of Health; Doctoral College Scholarship and received research grants from the University of; Dr Wildi reports funding from the University of Basel, the Swiss National; Fondazione Ricerca Molinette (Torino, Italy; Foundation (320030-231521), the Wesley Medical Research Foundation, and the; Foundation (FF23062), unrelated to the present work. Dr Lopez-Ayala has received; Foundation (P400PM_191037/1), the Prof Dr Max Cloetta Foundation, the Margarete; Foundation, the Swiss National Science Foundation, and the "Freie Akademische; Gesellschaft Basel"; Idorsia, LSI-Medience, Roche, Ortho Clinical Diagnostics, Quidel, Siemens,; MSD, Bristol-Myers Squibb, Pfizer, The Medicine Company, Otsuka, Thermo Fisher,; Martin-Sanchez has received speaker, advisory, or consulting fees from Novartis,; Medical Sciences, and the Gottfried and Julia Bangerter-Rhyner Foundation, as; Medtronic, Abbott, Beckman Coulter, Bayer, Ortho Clinical Diagnostics, and Orion; Nestelberger has received research support from the Swiss National Science; Novartis, Ortho Clinical, Quidel, Roche, Siemens, Singulex, SpinChip, Upstream,; Ortho Clinical Diagnostics, Quidel Corporation, and Beckman Coulter; Pharma, outside the submitted work. Dr Boeddinghaus is supported by an Edinburgh; Science Foundation, the Swiss Heart Foundation, the University Hospital Basel,; SpinChip, and Singulex, outside the submitted work, all paid to the institution; SpinChip, and Singulex. The Turin-cancer cohort study was supported by the; Swiss Academy of Medical Sciences, the Gottfried and Julia Bangerter-Rhyner; University Hospital Basel, as well as speaker/consulting honoraria or research; University Hospital Basel, the University of Basel, Abbott, Beckman Coulter,; University of Queensland, all outside submitted work. Dr Morello received grants; We disclose that Dr Bima has received a research grant from the Swiss Heart; analysis. All authors have read and approved the manuscript. The sponsors had no; and FEDER, Mapfre, Novartis, Bayer, MSD, Abbott, and Orion-Pharma, outside the; and Sphingotec, as well as speaker honoraria/consulting honoraria from Abbott,; and travel; assay was donated by the manufacturer, who had no role in the design of the; by the Universita degli Studi di Torino (grants MORF_RILO_21_02 and 23_03 to FM).; cancer; cardiac troponin; cutoffs; decision to submit the manuscript for publication. The authors designed the; degli Studi di Torino and Fondazione Ricerca Molinette. All other authors declare; diagnosis; e-print servers; from Roche Diagnostics, Abbott, and Siemens, outside the submitted work. Dr; from the Swiss National Science Foundation, the Swiss Heart Foundation, the; from the University of Torino. Dr Lupia received grant support from Universita; has received a research grant from the University of Basel, the Swiss Academy of; honoraria from Quidel, paid to the institution, outside the submitted work. Dr; honoraria from Siemens Healthineers, Roche Diagnostics,; myocardial infarction; paper, and decided to publish. Drs Bima, Lopez-Ayala, Wildi, Nestelberger,; prognosis; published previously and are not being considered for publications elsewhere in; research grants from the Swiss Heart Foundation (FF20079 and FF21103) and speaker; responsibility for the integrity of the data and the accuracy of the data; role in designing or conducting the study and no role in gathering or analyzing; study, gathered and analyzed the data, vouch for the data and analysis, wrote the; study, the analysis of the data, the preparation of the manuscript, or the; submitted work. Dr Mueller has received research support from the Swiss National