Diagnostic performance of a common algorithm for cardiac troponin in acute myocardial infarction

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Abstract Background A major limitation of diagnostic algorithms for suspected myocardial infarction (MI) is their reliance on assay-specific high-sensitivity cardiac troponin (hs-cTn) cut-off concentrations and change criteria. Recently, the common change criteria (3C) have been proposed as an approach to risk stratification which utilizes universal, assay-independent criteria for hs-cTn assays Purpose We sought to evaluate a 3C algorithm for hs-cTn and compare its performance to established algorithms for the rule-out and rule-in of MI. Methods We used data from two prospective cohort studies (with 3 different hs-cTn assays) of patients presenting to the emergency department with suspected MI who had serial hs-cTn results available: the Biomarkers in Acute Cardiac Care (BACC) cohort from Germany and the Christchurch cohort from New Zealand. The 3C algorithm was applied and compared to established ESC algorithms (Figure 1). Diagnostic performance measures (sensitivity, specificity, predictive values, likelihood ratios) for MI were obtained for both 3C (change criteria >|3| for under 10 ng/L, >|30|% between 10-100 ng/L and >|15|% for above 100 ng/L) and the ESC algorithms for rule-in and rule-out. Confusion matrices, net reclassification improvement (NRI), and effectiveness (percentage rule-in and rule-out) analyses were also performed. Results In 5011 patients, the MI prevalence was 16.12% (n=811). Comparable diagnostic accuracy in terms of sensitivity, specificity, and predictive values were observed between the 3C and ESC algorithms. Direct comparison of the algorithms via NRI showed no decisive advantage for either algorithm (Figure 2). Confusion matrices for all three assays for both 0/1h and 0/2h sampling identified that the 3C ruled-in more patients with a MI who were ruled-out with the ESC. Conclusions The 3C algorithm performs similarly to the ESC 0/1h and 0/2h algorithms for risk stratifying patients for possible MI across three different hs-cTn assays. The 3C algorithm has the advantage of being assay-agnostic and has demonstrated comparable performance in the settings of both the 0/1h and 0/2h sampling.

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