Derivation and Validation of ESC-0/1-h Algorithm for High-Sensitivity Troponin T and I in Cancer Patients

• Published in: JACC. Advances (Online) Vol. 4; no. 6; p. 101821
• Main Authors: Bima, Paolo, Lopez-Ayala, Pedro, Koechlin, Luca, Morello, Fulvio, Boeddinghaus, Jasper, Dimitrova, Mihaela, Spagnuolo, Carlos C., Kaplan, Emel, Nestelberger, Thomas, Glaeser, Jonas, Wildi, Karin, du Fay de Lavallaz, Jeanne, Morawiec, Beata, Miro, Oscar, Martínez-Nadal, Gemma, Martin-Sanchez, Francisco J., Christ, Michael, Slankamenac, Ksenija, Labarile, Giulia, Lindahl, Bertil, Giannitsis, Evangelos, Lupia, Enrico, Mueller, Christian, Gimenez, Maria Rubini, Okamura, Bernhard, Muench-Gerber, Tamar S., Sanzone, Alessandra, Zimmermann, Tobias, Wussler, Desiree, Walter, Joan, Badertscher, Patrick, Puelacher, Christian, Keller, Dagmar, Breidthardt, Tobias, Potlukova, Eliska, Kawecki, Damian, Geigy, Nicolas, Rentsch, Katharina, Munzk, Piotr, Martinez-Nadal, Gemma, Adrada, Esther Rodriguez, Ganovská, Eva, Parenica, Jiri, von Eckardstein, Arnold, Campodarve, Isabel, McCord, James, Nowak, Richard, Body, Richard, deFilippi, Christopher R., Christenson, Robert H., Panteghini, Mauro, Plebani, Mario, Verschuren, Franck, French, John, Weiser, Silvia, Jernberg, Tomas, Alquézar-Arbé, Aitor, Ordonez-Llanos, Jordi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2025; Elsevier
• Subjects: cancer; cardiac troponin; Cardiovascular; cutoffs; diagnosis; myocardial infarction; Original Research; prognosis; cutoffs; NSTEMI; cardiac troponin; myocardial infarction; diagnosis; prognosis; ESC; NPV; PPV; hs-cTn; cancer; cTn; MI; ED; positive predictive value; emergency department; European Society of Cardiology; non-ST-segment elevation myocardial infarction; high-sensitivity cardiac troponin; negative predictive value
• ISSN: 2772-963X; 2772-963X
• DOI: 10.1016/j.jacadv.2025.101821

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. 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. 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. 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). Cancer-optimized ESC 0/1-h hs-cTnT/I algorithm cutoffs increased efficacy maintaining high safety. [Display omitted]