Elsevier

International Journal of Cardiology

Volume 319, 15 November 2020, Pages 140-143
International Journal of Cardiology

Short communication
Comparison of two biomarker only algorithms for early risk stratification in patients with suspected acute coronary syndrome

https://doi.org/10.1016/j.ijcard.2020.06.066Get rights and content
Under a Creative Commons license
open access

Highlights

  • Biomarker only algorithms used in patients with possible ACS.

  • 0/1 h algorithm and clinical chemistry score algorithm provide high NPV.

  • Both algorithms can be used at 0 and 3 h sampling timeframes.

Abstract

Background

We developed a biomarker algorithm encompassing the clinical chemistry score (CCS; which includes the combination of a random glucose concentration, an estimated glomerular filtration rate and high-sensitivity cardiac troponin; hs-cTn) with the Ortho Clinical Diagnostics hs-cTnI assay (CCS-serial) and compared it to the cutoffs derived from Ortho Clinical Diagnostics 0/1 h (h) algorithm for 7-day myocardial infarction (MI) or cardiovascular (CV)-death.

Methods

The study cohort was an emergency department (ED) population (n = 906) with symptoms suggestive of acute coronary syndrome (ACS) who had two Ortho hs-cTnI results approximately 3 h apart. Diagnostic parameters (sensitivity/specificity/negative predictive value; NPV/positive predictive value; PPV) were derived for the CCS-serial and the 0/1 h algorithm for 7-day MI/CV-death. A safety analysis was performed for patients in the rule-out arms of the algorithms for 30-day MI/death.

Results

The CCS-serial algorithm yielded 100% sensitivity/NPV (32% low-risk) and 95.7% specificity/65% PPV (11% high-risk). The 0/1 h algorithm-cutoffs yielded sensitivity/NPV/specificity/PPV of 97.8%/99.4%/91.3%/50%, which classified 38% of patients as low-risk and 16% of patients as high-risk. Four patients (1.2%) in the 0/1 h algorithm-cutoff rule-out arm had a 30-day MI/death outcome as compared to zero patients in the CCS-serial rule-out arm (p = 0.06).

Conclusion

Both the CCS-serial and 0/1 h algorithm cutoffs yield high NPVs with a similar proportion of patients identified as low-risk. These data may be useful for sites who are unable to collect samples at 0/1 h in the emergency department.

Keywords

High-sensitivity cardiac troponin
Glucose
eGRF
Acute coronary syndrome
Emergency department
Myocardial infarction
Cardiovascular death

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