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.
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.
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)
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.