Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w

Impact of smoking on high-sensitivity troponin levels and the performance of the ESC 0/1h algorithm in suspected myocardial infarction

B. Toprak1, J. Lehmacher1, N. A. Sörensen1, L. Guo1, P. Haller1, T. Hartikainen2, A. Schock1, D. Westermann2, S. Blankenberg1, T. Zeller1, J. T. Neumann1, R. Twerenbold1, für die Studiengruppe: BACC

1Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; 2Klinik für Kardiologie und Angiologie, Universitäts-Herzzentrum Freiburg / Bad Krozingen, Bad Krozingen;

Introduction: Tobacco smoking is associated with an increased risk of cardiovascular disease. Unexpectedly and paradoxically, recent population based-studies reported lower levels of high-sensitivity cardiac troponin (hs-cTn) in current smokers than in never and former smokers. In patients with suspected myocardial infarction (MI) in the acute setting, the association between smoking and hs-cTn concentrations and its potential impact on the safety and accuracy of the ESC 0/1h algorithm has never been investigated. Purpose: To examine the effect of smoking status (current, never and former smokers) i) on hs-cTn levels as measured by five different assays and ii) on the performance of the ESC 0/1h algorithm using two different hs-cTn assays in patients with symptoms suggestive of MI. Methods: We used data from an ongoing prospective cohort study investigating patients presenting with suspected MI to the emergency department of a German tertiary care center. Final diagnoses were independently adjudicated according to the 4th Universal Definition of MI. Troponin was measured by five different hs-cTn assays at time of presentation (0h) and after 1h. The diagnostic accuracies of hs-cTn at 0h and 1h, as assessed by the area under the receiver operating characteristics curves (ROC-AUC), was compared between current smokers and never/former smokers. To investigate the performance of the ESC 0/1h algorithm in current versus never/former smokers, parameters for the safety of rule-out (sensitivity and negative predictive value [NPV]), accuracy of rule-in (specificity and positive predictive value [PPV]) as well as efficacy (proportion triaged towards rule-out or rule-in) were calculated for Architect hs-cTnI and Elecsys hs-cTnT. Results: Among 2,527 patients with suspected MI, 562 (22.2%) were current smokers, 1,352 (53.5%) never and 613 (24.3%) former smokers. The prevalence of MI was comparable between the three groups, while age as well as several cardiovascular risk factors differed across the smoking categories. Across all available assays at 0h and 1h, hs-cTn levels were lower in current smokers (e.g. for 0h Architect hs-cTnI 4.8 [2.3, 14.8] ng/L) than in never smokers (5.6 [2.6, 16.2] ng/L) and former smokers (6.2 [2.9, 15.9] ng/L), while concentrations were rather similar between the latter (Table 1). Diagnostic accuracies of hs-cTn were high and did not differ between current and never/former smokers regarding the ROC-AUC for MI, neither based on 0h Architect hs-cTn I (AUC 0.89 [0.85-0.93) vs. 0.88 [0.86-0.90], p=0.72) and 1h Architect hs-cTn I (AUC 0.94 [0.91-0.97] vs. 0.92 [0.90-0.94], p=0.22), nor on 0h Elecsys hs-cTnT (AUC 0.87 [0.82-0.91] vs. 0.87 [0.85-0.89], p=0.79) and 1h Elecsys hs-cTnT (AUC 0.94 [0.92-0.96] vs. 0.92 [0.90-0.94], p=0.086). Applying the ESC 0/1h-algorithm using Architect hs-cTnI provided a very high and comparable safety for ruling-out MI in 47.8% of current vs. 41.4% of never/former smokers. Rule-in accuracy was also similar in current vs. never/former smokers, while the observe zone was slightly larger in never/former smokers (Figure 1). Similar findings were confirmed for Elecsys hs-cTnT. Conclusion: Despite paradoxically, but consistently lower concentrations of hs-cTn I and T in current than in never or former smokers with suspected MI, the ESC 0/1h algorithm achieves very high and overall comparable safety, accuracy and efficacy irrespective of smoking status.

https://dgk.org/kongress_programme/jt2023/aP1295.html