ArticleIrish journal of medical science2026
Rule-Out yield of the European society of cardiology 0/1-Hour troponin protocol in frail and non-frail octogenarians.
Article in Irish journal of medical science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate the rule-out yield of the European Society of Cardiology (ESC) 0/1-h high-sensitivity cardiac troponin I (hs-cTnI) algorithm for 30-day major adverse cardiac events (MACE) in emergency department (ED) patients aged ≥ 80 years, and explore whether frailty modifies performance.
methodsThis retrospective single-center cohort study included patients aged ≥ 80 undergoing 0/1-h hs-cTnI sampling for suspected acute coronary syndrome. Frailty was defined using the Clinical Frailty Scale (≥ 5). The prespecified primary outcome was the 30-day MACE miss rate in the rule-out stratum against a 1% threshold.
resultsOf 1,136 screened encounters, 800 were analyzed (median age 83 years; 56.9% female); 312 (39.0%) were frail. Blinded re-abstraction of 80 records yielded kappa 0.82 (0.71-0.93) for frailty and agreement ≥ 0.71 across variables. The algorithm classified 120 patients (15.0%) as rule-out (prespecified target, 236); two had 30-day MACE (miss rate 1.7%; wide 95% Wilson CI, 0.5%-5.9%), an imprecise estimate whose upper bound exceeds the 1% threshold. A post hoc bounding analysis counting all 11 rule-out patients with incomplete nonfatal ascertainment as events raised the upper bound to 10.8% (6.4%-17.7%). Sensitivity was 99.0% and negative predictive value 98.3%. In prespecified exploratory analysis, no statistically significant independent association was observed between frailty and 30-day MACE (average marginal effect + 1.03 percentage points; 95% CI, -5.05 to + 7.20; p = 0.744).
conclusionsThe ESC algorithm ruled out only 15% of octogenarians, potentially reflecting baseline age- and renal-related troponin elevations. Limited rule-out sample size, wide confidence intervals, and incomplete follow-up prevent a definitive safety conclusion.
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