BACKGROUND: The diagnostic performance of high-sensitivity cardiac troponin T/I (hs-cTnT/I) and the efficacy of the European Society of Cardiology (ESC) 0/1-h hs-cTnT/I algorithms for the early diagnosis of non-ST-elevation myocardial infarction are lower in cancer patients. OBJECTIVES: The authors aimed to derive new cutoffs for ESC 0/1-h hs-cTnT/I algorithms optimized for use in patients with active or past cancer. METHODS: Patients presenting with suspected non-ST-elevation myocardial infarction to the emergency department enrolled in an international multicenter study were analyzed. Final diagnoses were centrally adjudicated by 2 independent cardiologists according to the fourth universal definition of myocardial infarction. External validation was performed in 2 independent cohorts. RESULTS: Among 541 eligible cancer patients, cancer-optimized ESC 0/1-h hs-cTnT cutoffs, <8 ng/L at presentation (if chest pain onset >3 hours) or <14 ng/L if 0/1 h-delta is <3 ng/L for rule-out and ≥54 ng/L or 0/1-h delta ≥4 ng/L for rule-in, increased the efficacy vs the current cutoffs from 58.6% (95% CI: 54.4-62.7) to 68.0% (95% CI: 64.0-71.8; P < 0.001). Sensitivity and specificity remained high and comparable. Similarly, among 516 eligible patients, cancer-optimized ESC 0/1-h hs-cTnI-Architect cutoffs, <7 ng/L at presentation (if chest pain onset >3 hours) or <10 ng/L if 0/1-h delta is <3 ng/L for rule-out and ≥61 ng/L or 0/1-h delta ≥5 ng/L for rule-in, increased the efficacy vs the current cutoffs from 59.3% (95% CI: 55.0-63.5) to 78.9% (95% CI: 75.2-82.2; P < 0.001). Sensitivity and specificity again remained high and comparable. Findings were confirmed in internal and external validation cohorts (n = 130 and n = 195 patients, respectively). CONCLUSIONS: Cancer-optimized ESC 0/1-h hs-cTnT/I algorithm cutoffs increased efficacy maintaining high safety.

2nd Department of Cardiology Faculty of Medical Sciences in Zabrze Medical University of Katowice Katowice Poland

Cardiovascular Research Institute Basel and Department of Cardiology University Hospital Basel University of Basel Basel Switzerland; GREAT Network Rome Italy

Cardiovascular Research Institute Basel and Department of Cardiology University Hospital Basel University of Basel Basel Switzerland; GREAT Network Rome Italy; BHF University Centre for Cardiovascular Science University of Edinburgh Edinburgh United Kingdom

Cardiovascular Research Institute Basel and Department of Cardiology University Hospital Basel University of Basel Basel Switzerland; GREAT Network Rome Italy; Department of Cardiac Surgery University Hospital Basel University of Basel Basel Switzerland

Cardiovascular Research Institute Basel and Department of Cardiology University Hospital Basel University of Basel Basel Switzerland; GREAT Network Rome Italy; Dipartimento di Scienze Mediche Università degli Studi di Torino Torino Italy

Department of Emergency Medicine Luzerner Kantonsspital Luzern Switzerland

Department of Medical Sciences Uppsala University Uppsala Sweden

Department of Medicine 3 University Hospital Heidelberger Heidelberg Germany

Dipartimento di Scienze Mediche Università degli Studi di Torino Torino Italy

Emergency Department Hospital Clinic Barcelona Catalonia Spain

Emergency Department Hospital Clínico San Carlos Madrid Spain

Emergency Department University Hospital Zurich Zurich Switzerland

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