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.
Tags: 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, 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, by the Universita degli Studi di Torino (grants MORF_RILO_21_02 and 23_03 to FM)., cancer, cardiac troponin, Cardiorentis, and Sanofi and research grants from the Spanish Ministry of Health, 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, Doctoral College Scholarship and received research grants from the University of, Dr Wildi reports funding from the University of Basel, the Swiss National, e-print servers., 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, 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, Gesellschaft Basel", 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,, Idorsia, LSI-Medience, Roche, Ortho Clinical Diagnostics, Quidel, Siemens,, 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, MSD, Bristol-Myers Squibb, Pfizer, The Medicine Company, Otsuka, Thermo Fisher,, myocardial infarction, 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, paper, and decided to publish. Drs Bima, Lopez-Ayala, Wildi, Nestelberger,, Pharma, outside the submitted work. Dr Boeddinghaus is supported by an Edinburgh, 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, 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, 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, support from Edwards Lifesciences, Pronova Medical, Meril, Boston Scientific,, support from Medtronic and Cordis, all outside the submitted work. Dr Koechlin, Swiss Academy of Medical Sciences, the Gottfried and Julia Bangerter-Rhyner, that they have no conflict of interest with this study. The investigated hs-cTn, the data or writing the manuscript. The manuscript and its contents have not been, the University of Basel, Abbott, Beckman Coulter, Brahms, Idorsia, LSI-Medience,, und Walter Lichtenstein-Stiftung (3MS1038), and the University of Basel, the, 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, well as the "Freiwillige Akademische Gesellschaft Basel," and speaker honoraria, whole or in part in any language, including publicly accessible web sites or.
RSS 2.0