The European Society of Cardiology (ESC) 0/1-h high sensitivity troponin T (hs-cTnT) algorithm does not differentiate risk based on known coronary artery disease (CAD: prior myocardial infarction [MI], coronary revascularization, or ≥ 70% coronary stenosis). We recently evaluated its performance among patients with known CAD at 30-days, but little is known about its longer-term risk prediction. The objective of this study is to determine and compare the performance of the algorithm at 90-days among patients with and without known CAD. We performed a pre-planned subgroup analysis of the STOP-CP cohort, which prospectively enrolled ED patients ≥21 years old with symptoms suggestive of ACS without ST-elevation on initial ECG across 8 US sites (1/25/2017–9/6/2018). Participants with 0- and 1-h hs-cTnT measures (Roche, Basel, Switzerland) were stratified into rule-out, observe, and rule-in groups using the ESC 0/1-h algorithm. Algorithm performance was tested among patients with or without known CAD, as determined by the treating provider. The primary outcome was cardiac death or MI at 90-days. Fisher's exact tests were used to compare 90-day event and rule-out rates between patients with and without known CAD. Negative predictive values (NPVs) for 90-day cardiac death or MI with exact 95% confidence intervals were calculated and compared using Fisher's exact test. The STOP-CP study accrued 1430 patients, of which 31.4% (449/1430) had known CAD. Cardiac death or MI at 90 days was more common in patients with known CAD than in those without [21.2% (95/449) vs. 10.0% (98/981); < 0.001]. Using the ESC 0/1-h algorithm, 39.6% (178/449) of patients with known CAD and 66.1% (648/981) of patients without known CAD were ruled-out (p < 0.001). Among rule-out patients, 90-day cardiac death or MI occurred in 3.4% (6/178) of patients with known CAD and 1.2% (8/648) without known CAD ( = 0.09). NPV for 90-day cardiac death or MI was 96.6% (95%CI 92.8–98.8) among patients with known CAD and 98.8% (95%CI 97.6–99.5) in patients without known CAD (p = 0.09). Patients with known CAD who were ruled-out using the ESC 0/1-h hs-cTnT algorithm had a high rate of missed 90-day cardiac events, suggesting that the ESC 0/1-h hs-cTnT algorithm may not be safe for use among patients with known CAD. High-Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification (STOP-CP; : ; ).

中文翻译：

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欧洲心脏病学会 0/1 小时算法在 90 天时在已知冠状动脉疾病患者中使用高灵敏度心肌肌钙蛋白 T 的表现

欧洲心脏病学会 (ESC) 0/1-h 高灵敏度肌钙蛋白 T (hs-cTnT) 算法不会根据已知的冠状动脉疾病（CAD：既往心肌梗死 [MI]、冠状动脉血运重建或 ≥ 70%）来区分风险冠状动脉狭窄）。我们最近评估了其在 30 天已知 CAD 患者中的表现，但对其长期风险预测知之甚少。本研究的目的是确定并比较算法在患有和不患有已知 CAD 的患者中在 90 天时的性能。我们对 STOP-CP 队列进行了预先计划的亚组分析，该队列前瞻性地纳入了 8 个美国站点（2017 年 1 月 25 日至 9 月 6 日）的 ED 患者，这些患者的症状提示有 ACS，但初始心电图无 ST 段抬高。 /2018）。使用 ESC 0/1-h 算法将进行 0 小时和 1 小时 hs-cTnT 测量的参与者（瑞士巴塞尔罗氏）分为排除组、观察组和纳入组。根据治疗提供者的决定，算法性能在患有或不患有已知 CAD 的患者中进行了测试。主要结局是 90 天时心源性死亡或 MI。Fisher 精确检验用于比较患有和不患有已知 CAD 的患者之间的 90 天事件率和排除率。使用 Fisher 精确检验计算并比较具有精确 95% 置信区间的 90 天心源性死亡或 MI 的阴性预测值 (NPV)。STOP-CP 研究招募了 1430 名患者，其中 31.4% (449/1430) 患有已知的 CAD。已知患有 CAD 的患者比不患有 CAD 的患者更常见 90 天时心源性死亡或 MI [21.2% (95/449) vs. 10.0% (98/981)；< 0.001]。使用 ESC 0/1-h 算法，排除了 39.6% (178/449) 已知 CAD 的患者和 66.1% (648/981) 不已知 CAD 的患者 (p < 0.001)。在排除的患者中，已知 CAD 的患者中有 3.4% (6/178) 发生 90 天心源性死亡或 MI，而没有已知 CAD 的患者则有 1.2% (8/648) (= 0.09)。已知 CAD 患者的 90 天心源性死亡或 MI 的 NPV 为 96.6% (95%CI 92.8–98.8)，而无已知 CAD 的患者则为 98.8% (95%CI 97.6–99.5) (p = 0.09)。使用 ESC 0/1-h hs-cTnT 算法排除的已知 CAD 患者的 90 天心脏事件漏诊率很高，这表明 ESC 0/1-h hs-cTnT 算法可能不安全适用于患有已知 CAD 的患者。高灵敏度心肌肌钙蛋白 T 可优化胸痛风险分层 (STOP-CP; : ; )。