Sex and race differences in the performance of the European Society of Cardiology 0/1‐h algorithm with high‐sensitivity troponin T

Abstract

AbstractThe diagnostic performance of the high‐sensitivity troponin T (hs‐cTnT) European Society of Cardiology (ESC) 0/1‐h algorithm in sex and race subgroups of US Emergency Department (ED) patients is unclear. A pre‐planned subgroup analysis of the STOP‐CP cohort study was conducted. Participants with 0‐ and 1‐h hs‐cTnT measures from eight US EDs (1/2017 to 9/2018) were stratified into rule‐out, observation, and rule‐in zones using the hs‐cTnT ESC 0/1 algorithm. The primary outcome was adjudicated 30‐day cardiac death or MI. The proportion with the primary outcome in each zone was compared between subgroups with Fisher's exact tests. The negative predictive value (NPV) of the ESC 0/1 rule‐out zone for 30‐day CDMI was calculated and compared between subgroups using Fisher's exact tests. Of the 1422 patients enrolled, 54.2% (770/1422) were male and 58.1% (826/1422) white with a mean age of 57.6 ± 12.8 years. At 30 days, cardiac death or myocardial infarction (MI) occurred in 12.9% (183/1422) of participants. Among patients stratified to the rule‐out zone, 30‐day cardiac death or MI occurred in 1.1% (5/436) of women versus 2.1% (8/436) of men (p = .40) and 1.2% (4/331) of non‐white patients versus 1.8% (9/490) of white patients (p = .58). The NPV for 30‐day cardiac death or MI was similar among women versus men (98.9% [95% confidence interval, CI: 97.3–99.6] vs. 97.9% [95% CI: 95.9–99.1]; p = .40) and among white versus non‐white patients (98.8% [95% CI: 96.9–99.7] vs. 98.2% [95% CI: 96.5–99.2]; p = .39). NPVs <99% in each subgroup suggest the hs‐cTnT ESC 0/1‐h algorithm may not be safe for use in US EDs. Trial Registration: High‐Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification (STOP‐CP; ClinicalTrials.gov: NCT02984436; https://clinicaltrials.gov/ct2/show/NCT02984436).