Lower diagnostic accuracy of hs-cTnI in patients with prior coronary artery bypass grafting
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Lower diagnostic accuracy of hs-cTnI in patients with prior coronary artery bypass grafting. / Koechlin, Luca; Boeddinghaus, Jasper; Nestelberger, Thomas; Lopez-Ayala, Pedro; Shrestha, Samyut; Wussler, Desiree; Haeni, Nicola; Walter, Joan Elias; Twerenbold, Raphael; Eckstein, Friedrich S; Reuthebuch, Oliver; McCord, James; Nowak, Richard M; Christenson, Robert H; deFilippi, Chistopher R; Apple, Fred S; Mueller, Christian; APACE and High-US investigators.
in: INT J CARDIOL, Jahrgang 354, 01.05.2022, S. 1-6.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Lower diagnostic accuracy of hs-cTnI in patients with prior coronary artery bypass grafting
AU - Koechlin, Luca
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Lopez-Ayala, Pedro
AU - Shrestha, Samyut
AU - Wussler, Desiree
AU - Haeni, Nicola
AU - Walter, Joan Elias
AU - Twerenbold, Raphael
AU - Eckstein, Friedrich S
AU - Reuthebuch, Oliver
AU - McCord, James
AU - Nowak, Richard M
AU - Christenson, Robert H
AU - deFilippi, Chistopher R
AU - Apple, Fred S
AU - Mueller, Christian
AU - APACE and High-US investigators
N1 - Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) and the ESC 0/1h-hs-cTnT-algorithm have worse performance in the early diagnosis of myocardial infarction (MI) in patients with prior coronary artery bypass grafting (CABG). It is unknown, whether this concern applies also to hs-cTnI, the most widely used analyte worldwide.METHODS: In an international multicenter diagnostic study, two cardiologists centrally adjudicated the final diagnosis in patients presenting to the emergency department with symptoms suggestive of MI according to the Third Universal Definition of MI. The objective was to compare the diagnostic accuracy of hs-cTnI assays and their performance within the ESC hs-cTnI 0/1h-algorithms in patients with versus without prior CABG. Findings were externally validated in an U.S. multicenter diagnostic study.RESULTS: A total of 392/5'200 patients (8%) had prior coronary artery bypass grafting (CABG). Diagnostic accuracy of hs-cTnI as quantified by the area under the receiver-operating characteristics-curve (AUC) in these patients was high, but lower versus patients without prior CABG (e.g. hs-cTnI-Architect 0.91 versus 0.95; p = 0.016). Sensitivity/specificity of rule-out/in by the European Society of Cardiology (ESC) 0/1h-hs-cTnI-algorithms remained very high [e.g. hs-cTnI-Architect 100% and 93.5%], but efficacy was lower (52% versus 74%, p < 0.01). External validation (n = 2113) confirmed these findings in 192 patients with prior CABG using hs-cTnI-Atellica, with 52% versus 36% (p < 0.001) remaining in the observe zone.CONCLUSIONS: Diagnostic accuracy of hs-cTnI and efficacy of the ESC 0/1h-hs-cTnI-algorithms are lower in patients with prior CABG, but sensitivity/specificity remain very high.CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT00470587, number NCT00470587.
AB - BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) and the ESC 0/1h-hs-cTnT-algorithm have worse performance in the early diagnosis of myocardial infarction (MI) in patients with prior coronary artery bypass grafting (CABG). It is unknown, whether this concern applies also to hs-cTnI, the most widely used analyte worldwide.METHODS: In an international multicenter diagnostic study, two cardiologists centrally adjudicated the final diagnosis in patients presenting to the emergency department with symptoms suggestive of MI according to the Third Universal Definition of MI. The objective was to compare the diagnostic accuracy of hs-cTnI assays and their performance within the ESC hs-cTnI 0/1h-algorithms in patients with versus without prior CABG. Findings were externally validated in an U.S. multicenter diagnostic study.RESULTS: A total of 392/5'200 patients (8%) had prior coronary artery bypass grafting (CABG). Diagnostic accuracy of hs-cTnI as quantified by the area under the receiver-operating characteristics-curve (AUC) in these patients was high, but lower versus patients without prior CABG (e.g. hs-cTnI-Architect 0.91 versus 0.95; p = 0.016). Sensitivity/specificity of rule-out/in by the European Society of Cardiology (ESC) 0/1h-hs-cTnI-algorithms remained very high [e.g. hs-cTnI-Architect 100% and 93.5%], but efficacy was lower (52% versus 74%, p < 0.01). External validation (n = 2113) confirmed these findings in 192 patients with prior CABG using hs-cTnI-Atellica, with 52% versus 36% (p < 0.001) remaining in the observe zone.CONCLUSIONS: Diagnostic accuracy of hs-cTnI and efficacy of the ESC 0/1h-hs-cTnI-algorithms are lower in patients with prior CABG, but sensitivity/specificity remain very high.CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT00470587, number NCT00470587.
KW - Biomarkers
KW - Coronary Artery Bypass
KW - Humans
KW - Myocardial Infarction/diagnosis
KW - Prospective Studies
KW - Troponin I
KW - Troponin T
U2 - 10.1016/j.ijcard.2022.02.025
DO - 10.1016/j.ijcard.2022.02.025
M3 - SCORING: Journal article
C2 - 35189168
VL - 354
SP - 1
EP - 6
JO - INT J CARDIOL
JF - INT J CARDIOL
SN - 0167-5273
ER -