A-015 Verification of the ESC hs-cTnT guidelines for suspected acute coronary syndromes: real world data

Abstract

Background High-sensitivity cardiac troponin T (Hs-cTnT) remains indispensable in the management of acute coronary syndromes (ACS). The European Society for Cardiology (ESC) 0/1- and 0/2-hour hs-cTnT algorithms are used to rule out ACS. Where serial testing is performed, the number of cases in the observed zone can be reduced in patients with moderately raised initial hs-cTnT values. We describe the distribution of rule-in/out subjects in our institution, using the ESC 0/2-hour hs-cTnT (Roche) algorithm. Methods We reviewed the hs-cTnT results of subjects with serial hs-cTnT testing between 2023 to 2024 (n = 868) and evaluated their results according to established ESC Roche hs-cTnT guidelines for ACS diagnostic categories. Subjects with an initial hs-cTnT of <5.0/>52 ng/L are immediately ruled-out/in for ACS. For subjects with initial hs-cTnT 5.0-14 ng/L, and a 0/2H delta of <4.0/>10 ng/L are ruled-out/in respectively; all other cases remained in the observation zone. For subjects with initial hs-cTnT >14 to 52 ng/L, a second sample delta <4.0 or 4.0-10 ng/L remains in observation while a delta >10 ng/L is ruled-in for ACS. Results The first hs-cTnT sample ruled out/in 40/355 subjects (4.6/40.9%), with 473 subjects (54.5%) requiring further observation. Only 1 of the 40 subjects ruled out for ACS had elevated 0/2H delta hs-cTnT (suspected early presenter, first and second sample 4.0 and 28 ng/L respectively). In the observation cohort, 147 subjects had an initial hs-cTnT between 5.0-14 ng/L, of which 129 had a delta <4.0 ng/L after a second sample, 9 had a delta of 4.0-10.0 ng/L, and 9 had a delta of >10.0 ng/L. 326 subjects had an initial hs-cTnT of >14-52 ng/L, of which 204 had a delta of <4.0 ng/L, 54 had a delta of 4.0-10.0 ng/L, and 68 had a delta of >10 ng/L. In total, this resulted in an additional 129/77 subjects being ruled-out/in for ACS after the second sample, with only 267 subjects (30.8%) remaining for further observation (see Figure 1), resulting in a total of 169 subjects being ruled out for ACS (4.6% to 19.5%), and a total of 432 subjects being ruled in (40.9% to 49.8%). Conclusion A single cut-off of an initial hs-cTnT of <5.0 ng/L resulted in 1 early presenter being ruled out for ACS (2.5%). Serial sampling is valuable to reduce the cases in the observation zone as well as increasing the number of rule-out/in cases. The 0/2-hour ESC algorithm performed well in our hospital.