High-Sensitivity Cardiac Troponins in Patients With Chest Pain and Treatment With Oral Antineoplastic Agents Associated With Cardiovascular Toxicity - 26/06/24
, Gustaf Edgren, MD, PhD b, cHighlights |
• | Diagnostic accuracy of high-sensitivity cardiac troponin T measurements for myocardial infarction is reduced among patients with chest pain on treatment with oral antineoplastic agents associated with cardiovascular toxicity. |
• | These patients have lower specificity and PPV in groups assigned toward high risk of myocardial infarction. |
• | Improved hs-cTnT-based strategies for myocardial infarction risk assessments are needed in patients treated with oral antineoplastic agents associated with cardiovascular toxicities. |
Abstract |
Background |
Knowledge is limited on the clinical implications of high-sensitivity cardiac troponin (hs-cTn) measurements in patients treated with oral antineoplastic agents associated with cardiovascular side effects. This study investigated the diagnostic performance of hs-cTnT for myocardial infarction.
Methods |
Among all visits to 7 different emergency departments (EDs) from December 9, 2010 to August 31, 2017, we included visits by patients presenting with chest pain who had ≥1 hs-cTnT measured. Patients treated with oral antineoplastic agents associated with cardiovascular toxicity were identified. Logistic regression models were used to estimate the performance of hs-cTnT for diagnosing myocardial infarction.
Results |
We identified 214,165 visits, of which 2695 (1.3%) occurred in patients with oral antineoplastic treatment associated with cardiovascular toxicity. Treatment was associated with a higher myocardial infarction incidence (8.2% vs 5.7%), but the overall diagnostic accuracy for a myocardial infarction was lower in patients with versus without treatment, paralleled by a lower specificity and PPV with the 0 h hs-cTnT rule-in cut-off of 52 ng/L (92.6% [95% CI: 91.6-93.6] vs 96.8% [95% CI: 96.8-96.9], and 42.8 [95% CI: 37.4-48.2] vs 49.5 [95% CI: 48.6-50.4], respectively). The majority (72%) of patients with treatment were assigned to an intermediate risk group, in whom the risk of myocardial infarction was reduced by 29% (OR 0.71, 95% CI: 0.57-0.89).
Conclusions |
Diagnostic accuracy of hs-cTnT for myocardial infarction is reduced among patients on treatment with oral antineoplastic agents associated with cardiovascular toxicity. Most patients would be assigned to an intermediate risk group, in whom only 4% will have a final myocardial infarction diagnosis.
Le texte complet de cet article est disponible en PDF.Graphical Abstract |
Keywords : Antineoplastic treatment, Cardiac biomarker, High-sensitivity cardiac troponin, Myocardial infarction
Plan
| Funding: No specific funding was obtained for this study. The work was supported by the Stockholm County Council (20200935 to A.R), the Swedish Research Council (2017-01954 to G.E) and Region Stockholm (clinical research appointment for G.E.). The sponsors had no role in the design or conduct of this study. |
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| Conflicts of Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
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| Authorship: All authors made substantial contribution to the design of the study protocol and in data analysis. All authors had access to the data and a role in writing the manuscript. The manuscript was critically revised and finally approved by each author. AR: Writing – review & editing, Writing – original draft, Visualization, Validation, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization. GE: Writing – review & editing, Validation, Supervision, Software, Resources, Project administration, Funding acquisition, Data curation, Conceptualization. |
Vol 137 - N° 7
P. 597 - juillet 2024 Retour au numéro
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