Julia Karady, MD

Pronouns

She/Her/Hers

Rank

Instructor

Institution

MGH

BWH-MGH Title

Research Fellow

Department

Radiology

Authors

Júlia Karády, MD, Thomas Mayrhofer, PhD, John T Nagurney, MD, MPH, James E Udelson, MD, Jerome L Fleg, MD, W Frank Peacock, MD, Bela Merkely, MD, PhD, James L Januzzi, Jr, MD, Wolfgang Koenig, MD, PhD, Micahel T Lu, MD, MPH, Maros Ferencik, MD, PhD, MCR, Udo Hoffmann, MD, MPH

Agreement between four high-sensitivity cardiac troponin assays and non-invasive testing, clinical and quality of care outcomes based on the 2020 ESC guidelines

WMSS 2022

For me it is very empowering to connect with female healthcare professionals, who probably go through similar difficulties as myself when it comes to choosing between professional excellence and personal choices such as motherhood. Knowing and seeing that many others out there manage to juggle and be excellent in all helps to embrace the sometimes difficult times.

Background

Quality-of-care and safety of patients with acute coronary syndrome (ACS) would benefit if management was independent of high-sensitivity cardiac troponin (hs-cTn) assays.

Methods

We analyzed blood samples from patients with suspected ACS using 4 hs-cTn assays (Roche Elecsys; Abbott ARCHITECT; Siemens HsVista; Beckman ACCESS). We determined the agreement between the assays to assign patients to rule-out/observe/rule-in management pathways per the European Society of Cardiology (ESC)2020 Guidelines. We assessed association with obstructive CAD/inducible myocardial ischemia and adjudicated clinical- and quality-of-care outcomes. We compared observed conventional troponin management with predicted hs-cTn assays-based management per ESC2020 Guidelines.

Results

Assignment to ESC2020 Guideline management pathways among 238 patients with suspected ACS (age 52.7±8.0years; 40.3% [96/238]female) was discordant in 26% across all hs-Tn assays. In rule-out strata, 19.1-21.6% had obstructive CAD or inducible myocardial ischemia and 3.3-4.2% had ACS. Predicted ED discharge rates based on hs-cTn assays were higher than those observed with conventional troponin (80.3% to 90.8% vs. 21.0%, p<0.001), and costs-of-care were lower ($2,578±2,896 to 2,894±4,371 vs. 3,889±4,833, p<0.001)

Conclusion

In patients presenting to the ED with suspected ACS ESC2020 Guideline-based management may be different, depending on the hs-cTn assay. Hs-cTn is predicted to significantly increase direct ED discharges and lower costs-of-care.