Evidence map›Paper›PMID 38001050›Full record

Trial reportEuropean heart journal. Acute cardiovascular care2024

Agreement among high-sensitivity cardiac troponin assays and non-invasive testing, clinical outcomes, and quality-of-care outcomes based on the 2020 European Society of Cardiology Guidelines.

Júlia Karády, Thomas Mayrhofer, James L Januzzi, James E Udelson, Jerome L Fleg, Bela Merkely, Michael T Lu, William F Peacock, John T Nagurney, Wolfgang Koenig and 2 more

Registry-linked trialAbstract readRandomized Controlled TrialClinical Trial, Phase III
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European heart journal. Acute cardiovascular care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01084239 (Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01084239 phase3completednot on this map

Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography

TypeinterventionalSponsorMassachusetts General HospitalRan2010 to 2012Enrolled1,000ConditionsAcute Coronary Syndrome, Myocardial Infarction, Unstable Angina PectorisArmsCardiac Computed Tomography
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Best of cardiovascular biomarkers.European heart journal. Acute cardiovascular care · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Júlia KarádyCardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St Suite 400, Boston, MA 02114, USA.ORCID 0000-0002-6640-6260
Thomas MayrhoferCardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St Suite 400, Boston, MA 02114, USA.
James L JanuzziDivision of Cardiology, Massachusetts General Hospital, Boston, MA, USA.ORCID 0000-0002-8338-1798
James E UdelsonDepartment of Medicine, Tufts Medical Center, Boston, MA, USA.
Jerome L FlegDivision of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
Bela MerkelyHeart and Vascular Center, Semmelweis University, 9-11 Gaál József Street, Budapest 1122, Hungary.
Michael T LuCardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St Suite 400, Boston, MA 02114, USA.
William F PeacockDepartment of Emergency Medicine, Baylor College of Medicine, Boston, MA, USA.
John T NagurneyDepartment of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Wolfgang KoenigInstitute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.ORCID 0000-0002-2064-9603
Maros FerencikCardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St Suite 400, Boston, MA 02114, USA.
Udo HoffmannCardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St Suite 400, Boston, MA 02114, USA.

Funding

NHLBI NIH HHSNIH HHS
6 · The paper itself

Abstract

aimsQuality-of-care and safety of patients with suspected acute coronary syndrome (ACS) would benefit if management was independent of which high-sensitivity cardiac troponin (hs-cTn) assay was used for risk stratification. We aimed to determine the concordance of hs-cTn assays to risk-stratify patients with suspected ACS according to the European Society of Cardiology (ESC) 2020 Guidelines. METHODS AND

resultsBlood samples were obtained at arrival and at 2 h from patients with suspected ACS using four hs-cTn assays. The patients were classified into rule-out/observe/rule-in strata based on the ESC 2020 Guidelines. Concordance was determined among the assays for rule-out/observe/rule-in strata. The prevalences of significant underlying disease (≥50% stenosis on coronary computed tomography or inducible myocardial ischaemia on stress testing) and adjudicated ACS, plus quality-of-care outcomes, were compared. Among 238 patients (52.7 ± 8.0 years; 40.3% female), the overall concordance across assays to classify patients into rule-out/observe/rule-in strata was 74.0% (176/238). Platforms significantly differed for rule-out (89.9 vs. 76.5 vs. 78.6 vs. 86.6%, P < 0.001) and observe strata (6.7 vs. 20.6 vs. 17.7 vs. 9.2%, P < 0.001), but not for rule-in strata (3.4 vs. 2.9 vs. 3.8 vs. 4.2%, P = 0.62). Among patients in ruled-out strata, 19.1-21.6% had significant underlying disease and 3.3-4.2% had ACS. The predicted disposition of patients and cost-of-care differed across the assays (all P < 0.001). When compared with observed strata, conventional troponin-based management and predicted quality-of-care outcomes significantly improved with hs-cTn-based strategies (direct discharge: 21.0 vs. 80.3-90.8%; cost-of-care: $3889 ± 4833 vs. $2578 ± 2896-2894 ± 4371, all P < 0.001).

conclusionAmong individuals with suspected ACS, patient management may differ depending on which hs-cTn assay is utilized. More data are needed regarding the implications of inter-assay differences. TRAIL REGISTRATION: NCT01084239.

Indexed as

Acute Coronary SyndromeTroponinBiomarkersCardiologyFemaleHumansMaleMiddle AgedBiomarkersTroponin0/2 h diagnostic algorithmAcute coronary syndromeHigh-sensitivity troponin assayNon-invasive diagnostic testingQuality-of-care outcomes

Identifiers

PMID38001050
PMCPMC10853690

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.