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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, Vol. 354, 01.05.2022, p. 1-6.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Koechlin, L, Boeddinghaus, J, Nestelberger, T, Lopez-Ayala, P, Shrestha, S, Wussler, D, Haeni, N, Walter, JE, Twerenbold, R, Eckstein, FS, Reuthebuch, O, McCord, J, Nowak, RM, Christenson, RH, deFilippi, CR, Apple, FS, Mueller, C & APACE and High-US investigators 2022, 'Lower diagnostic accuracy of hs-cTnI in patients with prior coronary artery bypass grafting', INT J CARDIOL, vol. 354, pp. 1-6. https://doi.org/10.1016/j.ijcard.2022.02.025

APA

Koechlin, L., Boeddinghaus, J., Nestelberger, T., Lopez-Ayala, P., Shrestha, S., Wussler, D., Haeni, N., Walter, J. E., Twerenbold, R., Eckstein, F. S., Reuthebuch, O., McCord, J., Nowak, R. M., Christenson, R. H., deFilippi, C. R., Apple, F. S., Mueller, C., & APACE and High-US investigators (2022). Lower diagnostic accuracy of hs-cTnI in patients with prior coronary artery bypass grafting. INT J CARDIOL, 354, 1-6. https://doi.org/10.1016/j.ijcard.2022.02.025

Vancouver

Koechlin L, Boeddinghaus J, Nestelberger T, Lopez-Ayala P, Shrestha S, Wussler D et al. Lower diagnostic accuracy of hs-cTnI in patients with prior coronary artery bypass grafting. INT J CARDIOL. 2022 May 1;354:1-6. https://doi.org/10.1016/j.ijcard.2022.02.025

Bibtex

@article{443a2eff91e741d4afd636ac8ae4a32c,
title = "Lower diagnostic accuracy of hs-cTnI in patients with prior coronary artery bypass grafting",
abstract = "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.",
keywords = "Biomarkers, Coronary Artery Bypass, Humans, Myocardial Infarction/diagnosis, Prospective Studies, Troponin I, Troponin T",
author = "Luca Koechlin and Jasper Boeddinghaus and Thomas Nestelberger and Pedro Lopez-Ayala and Samyut Shrestha and Desiree Wussler and Nicola Haeni and Walter, {Joan Elias} and Raphael Twerenbold and Eckstein, {Friedrich S} and Oliver Reuthebuch and James McCord and Nowak, {Richard M} and Christenson, {Robert H} and deFilippi, {Chistopher R} and Apple, {Fred S} and Christian Mueller and {APACE and High-US investigators}",
note = "Copyright {\textcopyright} 2022 The Author(s). Published by Elsevier B.V. All rights reserved.",
year = "2022",
month = may,
day = "1",
doi = "10.1016/j.ijcard.2022.02.025",
language = "English",
volume = "354",
pages = "1--6",
journal = "INT J CARDIOL",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

RIS

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 -