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Multicenter Study
. 2021 May;8(1):e001682.
doi: 10.1136/openhrt-2021-001682.

Use of historical high-sensitivity cardiac troponin T levels to rule out myocardial infarction

Andreas Roos  1   2 , Martin J Holzmann  3   2
Affiliations
Multicenter Study

Use of historical high-sensitivity cardiac troponin T levels to rule out myocardial infarction

Andreas Roos et al. Open Heart. 2021 May.

Abstract

Objective: Several high-sensitivity cardiac troponin (hs-cTn)-based strategies exist for rule-out of myocardial infarction (MI). It is unknown whether historical hs-cTnT concentrations can be used. This study aim to evaluate the performance of a rule-out strategy based on the European Society of Cardiology (ESC) 0/1-hour algorithm, using historical hs-cTnT concentrations.

Methods: All visits among patients with chest pain in the emergency department at nine different hospitals in Sweden from 2012 to 2016 were eligible (221 490 visits). We enrolled patients with a 0-hour hs-cTnT of <12 ng/L, a second hs-cTnT measured within 3.5 hours, and ≥1 historical hs-cTnT available. We calculated the risks of MI and all-cause mortality using two rule-out strategies: (1) a delta hs-cTnT of <3 ng/L between the 0-hour hs-cTnT and the second hs-cTnT (modified ESC algorithm) and (2) a historical hs-cTnT <12 ng/L and a delta hs-cTnT of <3 ng/L in relation to the 0-hour hs-cTnT (historical-hs-cTnT algorithm).

Results: A total of 8432 patients were included, of whom 84 (1.0%) had an MI. The modified ESC algorithm triaged 8100 (96%) patients toward ruled-out, for whom 30-day MI risk and negative predictive value (NPV) for MI (95% CI) were 0.4% (0.3% to 0.6%) and 99.6% (99.4% to 99.7%), respectively. The historical-hs-cTnT algorithm ruled out 6700 (80%) patients, with a 30-day MI risk of 0.5% (0.4% to 0.8%) and NPV of 99.5% (99.2% to 99.6%).

Conclusions: The application of algorithm resulted in similar MI risk and NPV to an established algorithm. The usefulness of historical hs-cTnT concentrations should merit further attention.

Keywords: biomarkers; chest pain; myocardial infarction.

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Conflict of interest statement

Competing interests: MJH has received consultancy honoraria from Idorsia and Pfizer.

Figures

Figure 1
Figure 1
Selection of the study population. hs-cTnT, high-sensitivity cardiac troponin T; STEMI, ST-segment elevation myocardial infarction.
Figure 2
Figure 2
Histogram and scatter plots of historical hs-cTnT, 0-hour hs-cTnT and second hs-cTnT concentrations. Red dots indicate patients who experienced an MI and blue dots indicate patients who did not. (A) 0-hour hs-cTnT concentration vs second hs-cTnT concentration. (B) Historical hs-cTnT concentration vs 0-hour hs-cTnT concentration. (C) Historical hs-cTnT concentration of <12 ng/L vs 0-hour hs-cTnT concentration. hs-cTnT, high-sensitivity cardiac troponin T; MI, myocardial infarction.
Figure 3
Figure 3
Comparison of two algorithms used to rule out myocardial infarction. All patients within the final population were eligible for both algorithms. The modified ESC algorithm triaged patients toward rule-out if the delta change between the 0-hour hs-cTnT concentration and the second hs-cTnT concentration measured 45 min to 3.5 hours from the 0-hour hs-cTnT was <3 ng/L. The historical-hs-cTnT algorithm triaged patients directly towards rule-out if the delta change between the historical hs-cTnT concentration and the 0-hour hs-cTnT concentration was <3 ng/L. ESC, European Society of Cardiology; hs-cTnT, high-sensitivity cardiac troponin T; LR−, negative likelihood ratio; MI, myocardial infarction; NPV, negative predictive value.
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