Clinical Chemistry Score Validated for AMI Rule-Out: Troponin Combined with eGFR and Glucose
External validation in 3,827 patients across an international multicenter study confirmed the Clinical Chemistry Score's high diagnostic accuracy for acute myocardial infarction, achieving an AUC of 0.90-0.91 for both hs-cTnT and hs-cTnI. A CCS of 0 points yielded 99.8% sensitivity for MI rule-out and 99.5% for 30-day MI/death. However, a single hs-cTn measurement approach provided comparable diagnostic and prognostic performance, questioning the incremental value of adding eGFR and glucose to the troponin-based assessment.
The original study
External validation of the clinical chemistry score.
- Authors
- Wildi K, Boeddinghaus J, Nestelberger T, Haaf P, Koechlin L, Ayala Lopez P, et al.
- Journal
- Clinical biochemistry
- Type
- Clinical Trial, Journal Article, Multicenter Study, Validation Study
- PMID
- 33636187
Original abstract
BACKGROUND: Combining high-sensitivity cardiac troponin (hs-cTn) with estimated glomerular filtration rate and glucose within the Clinical Chemistry Score (CCS) could help in the assessment of patients with suspected acute myocardial infarction (AMI). METHODS: In patients presenting with suspected AMI to the emergency department, we aimed to externally validate the performance of the CCS in a prospective international multicenter study and to directly compare the diagnostic and prognostic performance of the CCS with hs-cTnT and hs-cTnI baseline levels alone using a single cut-off approach. The diagnostic endpoint was diagnostic accuracy for AMI as centrally adjudicated by two independent cardiologists including cardiac imaging and serial hs-cTnT/I measurements. The prognostic endpoint was 30-day AMI or death. RESULTS: AMI was the final diagnosis in 620/3827 patients (16.2%) adjudicated with hs-cTnT and 599 patients (15.7%) adjudicated with hs-cTnI. The CCS resulted in high diagnostic accuracy for AMI and prognostic accuracy for 30-days AMI/death as quantified by the area under the receiver-operating characteristic curve (AUC), using hs-cTnT 0.90 (95%CI 0.89-0.91) and 0.89 (95%CI 0.88-0.90), using hs-cTnI 0.91 (95%Cl 0.90-0.92) and 0.90 (95%CI 0.89-0.91) respectively. E.g. a CCS of 0 points resulted in a sensitivity of 99.8% (95%CI 99.1-100%) for rule-out of index AMI and 99.5% (95%CI 98.5-100%) for AMI/death at 30 days for hs-cTnT and 99.8% (95%CI 98.9-100%) and 99.6% (95%CI 98.6-100%) using hs-cTnI. Overall, the single hs-cTnT/I measurement approach provided comparable diagnostic (sensitivity 99.5-99.7%) and prognostic (sensitivity 98.9-99.5%) performance versus the CCS. INTERPRETATION: The CCS provided high diagnostic and prognostic performance also in this independent large validation cohort. A single hs-cTnT/I measurement approach for rule-out MI yielded similar estimates.