Modified HEART score, utilising a single high-sensitive troponin sample, allows early, safe discharge of suspected acute coronary syndrome: a prospective multicentre cohort study of 3016 patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Khand ◽  
M Obeidat ◽  
M Campbell ◽  
K Batouskaya ◽  
L Mullen ◽  
...  
Keyword(s):  
Limit Of Detection ◽  
Troponin T ◽  
Public Institution ◽  
Risk Scores ◽  
Funding Source ◽  
Catchment Population ◽  
Heart Score ◽  
Coronary Syndrome ◽  
High Sensitive Troponin

Abstract Background Combining HSTnT (high sensitive troponin T) values at low levels with composite risk scores may improve early safe, discharge in suspected acute coronary syndromes (ACS). We tested this hypothesis by a prospective study of 3016 consecutive patients with suspected ACS in 2 large hospitals. Methods Consecutive chest pain (CP) presentations with HSTnT sampled and ECG undertaken at presentation were prospectively defined in 2 time periods (2011-12, n=1642 [derivation] 2018, n=1376 [validation]). The HstnT input was modified: dichotomous HSTnT input was lowered to <5 (limit of detection, LOD) or ≥5ng/l (mod TIMI and GRACE), HEART score was re-calibrated (<5 = 0 [LOD], ≥5–14 = 1, >14 = 2 [99th percentile]). All biomarker positive CP index and re-admissions to any regional hospital (catchment population 2.6 million) were independently adjudicated for MI by 2 experienced physicians. Primary outcome was MACE (adjudicated type 1 MI, unplanned coronary revascularisation and all cause death) at 6 weeks. Results In the 2 cohorts demographic factors were similar: median age 59 and 56, male 52% and 52%, previous MI 20% and 14% for 2011-12 and 2018 respectively. At 6 weeks 180 (11%) and 75 (5.4%) suffered type 1 MI and 211 (12.9%) and 92 (6.7%) patients suffered MACE in the 2011-12 and 2018 cohorts respectively. Only Mod HEART ≤3 and undetectable HSTnT, with a nonischaemic ECG, achieved prespecified NPV of >99.5% in both derivation and validation cohorts (table). However Modified HEART ≤3 score could discharge approximately 12% more patients as compared to undetectable HSTnT strategy. Conclusion Modified HEART score ≤3, with the use of a single HSTnT, appears the optimum early discharge strategy for suspected ACS Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Liverpool university Hospitals, North-West Educational Cardiac Group

Validation and comparison of six risk scores for post acute myocardial infarction infection

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y.H Liu ◽  
L.T Wang ◽  
Y.N Dai ◽  
L.H Zeng ◽  
H.L Fan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Score ◽  
Public Institution ◽  
Risk Scores ◽  
Funding Source ◽  
Good Discrimination ◽  
Chads2 Score ◽  
Coronary Syndrome ◽  
Clinical Events ◽  
Grace Score

Abstract Background Various risk scores have been proven to predict outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). However, few of them were validated and compared the difference of the prediction of infection during hospitalization in such patients. Aim We aimed to validate and compare the discriminatory value of different risk scores for predicting infection. Methods Patients who were diagnosed with STEMI treated with PCI were enrolled from January 2010 to May 2018. The six risk scores included the Age, Serum Creatinine (SCr), or Glomerular Filtration Rate, and Ejection Fraction (ACEF or AGEF) score, Canada Acute Coronary Syndrome Risk Score (CACS score), CHADS2 score, Global Registry for Acute Coronary Events (GRACE) score and Mehran score. The primary end point was infection during hospitalization. The secondary endpoint was major adverse clinical events including all cause death, stroke and any bleeding. The prognostic accuracy of the six scores was assessed using the c statistic for discrimination and the Hosmer-Lemeshow test for calibration. Results A total of 2260 eligible patients were enrolled (62.32±12.36 year, 81.3% of males). A significant gradient of risk with respect to infection and in hospital major adverse clinical events (MACE) was observed with increasing all six risk scores. Other than the CHADS2 score (AUC: 0.682; 95% CI, 0.652–0.712), other five risk scores showed the good discrimination for predicting infection, with the GRACE score being the best (AUC: 0.791; 95% CI, 0.765–0.817). In addition, all risk scores showed best calibration for infection, but good calibration for CACS risk score (calibration slope: 0.77, 95% CI: 0.18–1.35) (Figure 1). Furthermore, each score showed a best discrimination for in hospital MACE, with AUCs ranging from 0.761 to 0.786, other than CACS risk score and CHADS2 risk score with AUC of 0.700 and 0.696, respectively. All risk scores showed best calibration for in hospital MACE. Conclusions In patients with STEMI undergoing PCI, these risk scores (ACEF, AGEF, CACS, GRACE and Mehran) showed good discrimination and calibration to predict infection and MACE. The CACS score was recommended for clinical use as its clinical variables were simple and practical. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): National Science Foundation for Young Scientists of China

scholarly journals Implementation of the ESC 0/3hour accelerated diagnostic protocol,utilising high sensitive troponin T, for suspected acute coronary syndrome:a study on clinical effectiveness involving 3016 patients

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
S Mohmed ◽  
M Campbell ◽  
K Batouskaya ◽  
M Obeidat ◽  
A Khand
Keyword(s):  
Length Of Stay ◽  
Acute Coronary Syndromes ◽  
Limit Of Detection ◽  
Troponin T ◽  
Discharge Rate ◽  
Clinical Effectiveness ◽  
Coronary Syndromes ◽  
High Sensitive Troponin ◽  
Rule Out

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Liverpool University Hospitals NHS Foundation Trust Background There have been relatively few studies detailing the real-world effectiveness and safety of accelerated diagnostic protocols (ADP), using high sensitivity troponins (HSTN). Purpose  To analyse the safety and effectiveness of early emergency room (ER) discharge following implementation of the ESC 0/3-hour ADP for suspected acute coronary syndromes (ACS) Method We prospectively studied 2 cohorts of consecutive suspected acute coronary syndromes (ACS) presentations to ER before (n = 1642) and after (n = 1376, 2 centres) implementation of the ESC 0/3-hour ADP incorporating limit of detection rule out. All index presentations with HSTNT (high sensitive troponin T) >99th percentile underwent independent two physician adjudication for MI (myocardial infarction) using all available data to six weeks.  Safety was defined by both NPV (negative predictive value) and sensitivity for type 1 or type 2 MI for those with ER discharge and clinical effectiveness by percentage ER discharge. Results In the pre-implementation period there was a higher prevalence of MI. Discharge from ER increased by >100% to 56% of the cohort, when the ADP was implemented. This correlated with a marked reduction in length of stay overall and a more modest reduction for those discharged from ER (table) The greatly increased ER discharge was safe with no signal for hazard. Analysis of HSTNT values and ECGS revealed a maximum ER discharge rate of 69%, by applying the 0/3-hour protocol, implying potential for further increasing safe ER discharge. Conclusions Implementation of an ADP with HSTNs is safe and effective for early rule-out and discharge of suspected ACS. Further research into the shortfall between theoretical and actual early ER discharge achieved is warranted. DischargePre-implementation0/3hour ADP implementationP valuen16421376% male52.352.1nsAge (median)5855<0.001Index Type 1 or 2 MI prevalence (%)11.96<0.001% discharged from ER2756<0.001Median total length of stay (hours) {global population}16.37.1<0.001Median length of stay (hours)- discharged from ER6.25.4<0.001NPV for index type 1 or 2 MI (discharged from ER)99.399.7nsSensitivity index type 1 or 2 MI (discharged from ER)98.597.6ns

A single high-sensitivity cardiac troponin T compared to the HEART score for a rapid rule-out of acute myocardial infarction at a prehospital emergency clinic

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.R Johannessen ◽  
D Atar ◽  
O.M Vallersnes ◽  
A.C.K Larstorp ◽  
I Mdala ◽  
...  
Keyword(s):  
Primary Care ◽  
Cardiac Troponin ◽  
Troponin T ◽  
High Sensitivity ◽  
Low Risk ◽  
Symptom Duration ◽  
Funding Source ◽  
Emergency Setting ◽  
Heart Score ◽  
Rule Out

Abstract Background Patients presenting with acute chest pain outside of hospitals represent a diagnostic challenge. Purpose We aimed to validate whether a single high-sensitivity cardiac troponin T (hs-cTnT) safely can rule out acute myocardial infarction (AMI) in a primary care emergency setting. In addition, we aimed to investigate if the hs-HEART (History, Electrocardiogram (ECG), Age, Risk factors, and hs-Troponin) score would add valuable diagnostic information. Methods This is a secondary analysis from a prospective diagnostic study, including 1711 patients with acute non-specific chest pain presenting to a primary care emergency clinic from November 2016 to October 2018. The European Society of Cardiology (ESC) 0/1-hour algorithm triages patients towards direct rule-out if the 0-hour hs-cTnT is below 5 ng/L, combined with a normal ECG and a 3-hour symptom duration. The hs-HEART score (0–10 points) was calculated retrospectively, and a score ≤3 points was considered low-risk. In addition, a modified hs-HEART score, with more comparable hs-cTnT cut-off values, was applied. The primary endpoint was AMI during the index episode; the secondary the 90-day incidence of AMI (including index) and all-cause death. Results Among 1711 patients, 61 (3.6%) had an AMI, and 525 (30.7%) were assigned towards direct rule-out. With no AMIs in this group, the rule-out safety was high (negative predictive value (NPV) and sensitivity 100%). The hs-HEART score triaged more patients (n=966) as low-risk, but missed six AMIs (NPV 99.4% and sensitivity 90.2%). The modified hs-HEART score (n=707, AMI=3) increased the low-risk sensitivity to 95.1%. The 90-day incidence of AMI and all-cause death in the direct rule-out, low-risk hs-HEART, and modified hs-HEART group, were 0.0%, 0.7%, and 0.4%, respectively. Conclusions The ESC direct rule-out approach, with a single hs-cTnT below 5 ng/L, combined with a normal ECG, and a 3-hour symptom duration, is superior to the two hs-HEART scores in ruling out AMI in a primary care emergency setting. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The Norwegian Research Fund for General Practice

Evolution of hospital discharge medication and 6 months outcomes of ST-Segment Elevation Myocardial Infarction patients in Portugal over the years

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.P De Sousa Bispo ◽  
T.F Mota ◽  
R Fernandes ◽  
P Azevedo ◽  
D Carvalho ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Discharge ◽  
Public Institution ◽  
Categorical Variables ◽  
Funding Source ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
Discharge Medication ◽  
St Segment

Abstract Objectives To assess the evolution of hospital discharge management, 6 months hospitalization and mortality over the years of all patients admitted with ST segment elevation myocardial infarction (STEMI) in Portugal. Methods A nationwide electronic prospective registry that included all patients admitted to Portuguese hospitals with a diagnosis of Acute Coronary Syndrome since 2002 until 2018 was used to collect all data relative to patients admitted with a STEMI diagnosis during that time frame. Data on demographic data, clinical status, revascularization strategy, discharge medication and 6 months hospitalization and mortality were obtained. We compared the data and its evolution over the years to assess for trends. For statistical analysis, Qui-square tests were used to assess trends in categorical variables, and Kruskal-Wallis tests were used to assess trends in numerical variables. A p-value <0.05 was considered statistically significant. Results During the study, a total of 23807 patients were admitted for STEMI in Portuguese hospitals, 74.3% were male and average age of 63.9±13.6 years. We report a progressive and significant increase the use of primary angioplasty versus fibrinolysis (24.3% to 98.4%, p<0.001), in coronary angioplasties (36.4% to 73.2%, p<0.001), in the use of drug-eluting stents (0% to 70.1%, p<0.001), and a decrease in the patients that underwent surgery (6.8% to 1.3%, p<0.001) and intra-aortic balloon pump (1.8% to 0%, p=0.009), resulting in a decrease in in-hospital mortality from 9.9% to 6.1% (p<0.001). At discharge, we report a progressive increase in the prescription of P2Y12 inhibitors (21.1% to 95.2%, p<0.001), beta-blockers (68.8% to 83.8%, p<0.001), RAAS inhibitors (69.5% to 86.7%, p<0.001) and statins (79.6% to 94.9%, p<0.001), while the prescription of aspirin (94.1% para 94.8%, p=0.428), calcium channel blockers (5.3% to 5.6%, p<0.684) stayed stable, and there was a decrease in the prescription of nitrates (52.9% to 5.8%, p<0.001). Hospital admissions at 6 months consistently and progressively reduced over time (18.6% to 8.5%, p<0.001) as well as mortality (6.7% para 4.3%, p<0.001). Conclusion Post discharge treatment of STEMI patients in Portuguese hospitals has evolved according to guidelines, with higher prescription of medication proven to reduce outcomes, resulting in lower hospitalization rates and mortality. 6 Month Outcomes over the years Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Sociedade Portuguesa de Cardiologia

P2677A combination of HEART score and a 0-hour/1-hour algorithm for early and safe triage tool for patients in observe zone

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Shiozaki ◽  
K Inoue ◽  
S Suwa ◽  
C C Lee ◽  
S J Chiang ◽  
...  
Keyword(s):  
Troponin T ◽  
High Sensitivity ◽  
Final Diagnosis ◽  
Low Risk ◽  
Observation Group ◽  
Abdominal Ultrasonography ◽  
Diagnostic Uncertainty ◽  
Heart Score ◽  
Coronary Syndrome ◽  
Risk Score System

Abstract Background The European Society Cardiology guidelines recommend that a 0-hour/1-hour (0–1hr) algorithm using high sensitivity cardiac troponin T (hs-cTnT) improves the early triage of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). However, diagnostic uncertainty remains in the 25–30% of patients assigned to “observe” group. Purpose To establish a step wise risk score system using HEART score and 0-hour/1-hour algorithm to identify the low risk group from observation group. Methods This study was a prospective, multi-center, observational study of patients with suspected NSTE-ACS admitted to five hospitals in Japan and Taiwan from 2014 to 2018, respectively. We applied the algorithm and calculated HEART score simultaneously. Patients were divided into three groups according to the algorithm: hs-cTnT below 12 ng/L and delta 1 hour below 3 ng/L were the “rule out” group; hs-cTnT at least 52 ng/L or delta 1 hour at least 5 ng/L were in the “rule in” group; the remaining patients were classified as the “observe” group. All patients underwent a clinical assessment the included medical history, physical examination, 12-lead ECG, continuous ECG monitoring, pulse oximetry, standard blood test, chest radiography, cardiac and abdominal ultrasonography. Patients presenting with congestive heart failure, terminal kidney disease on hemodialysis state, arrhythmia, or infection disease (which causes to increase troponin level) were excluded. Thirty-day MACE was defined as acute myocardial infarction, unstable angina (UA), or death. Results Of the 1,332 patients enrolled, 933 patients were analyzed after exclusion. NSTE-ACS was the final diagnosis for 122 (13.1%) patients and none of death. The HEART score less than 4 points in observation groups identified as very low risk with a negative predictive value (NPV) of 98.1% (95% confidential interval (CI); 90.1%-100%) and sensitivity of 98.0% (95% CI; 89.6%-100%). There were only one patient (0.5%) with AMI. In case of the HEART score less than 5 points, it could also identify as very low risk with a NPV of 96.7% (95% CI; 90.8%-99.3%%) and sensitivity of 94.1% (95% CI; 83.8%-98.8%). There were only three patients (1.2%) with AMI. Conclusion A combination of HEART score and the 0-hour/1-hour algorithm strategy rapidly identified the patient in observation group of 30-day MACE including UA where nor further cardiac testing would be needed. Acknowledgement/Funding JSPS KAKENHI Grant Number JP18K09554

Clinical Impact of High Sensitive Troponin T (HsTnT) on Diagnosis of Acute Coronary Syndrome (ACS)

2011 ◽  
Vol 20 (6) ◽  
pp. 400
Author(s):  
J. Mazhar ◽  
V. Pera ◽  
A. Siddiqui ◽  
J. Bouwhuis ◽  
S. DuToit ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Troponin T ◽  
Clinical Impact ◽  
Coronary Syndrome ◽  
High Sensitive Troponin

scholarly journals Clinical Impact of High Sensitive Troponin T (HsTnT) on Diagnosis of Acute Coronary Syndrome (ACS)

2011 ◽  
Vol 20 ◽  
pp. S27 ◽  
Author(s):  
J. Mazhar ◽  
V. Pera ◽  
A. Siddiqui ◽  
J. Bouwhuis ◽  
S. Du Toit ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Troponin T ◽  
Clinical Impact ◽  
Coronary Syndrome ◽  
High Sensitive Troponin

Young patients with type 1 diabetes mellitus are characterised by high frequency of masked hypertension that is associated with increased arterial stiffness

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Troitskaya ◽  
Y Stavtseva ◽  
D Medvedev ◽  
A Petrosyan ◽  
A Safarova ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Arterial Stiffness ◽  
High Frequency ◽  
Young Patients ◽  
Public Institution ◽  
Laboratory Evaluation ◽  
Funding Source ◽  
Masked Hypertension ◽  
History Of

Abstract Background Hypertension (HTN) is a major risk factor for microvascular complications and cardiovascular disease (CVD) in individuals with type 1 diabetes (T1D). Masked and nocturnal HTN are associated with increased cardio-vascular (CV) risk and may be common in patients with T1D. Increased arterial stiffness (AS) is associated with elevated blood pressure (BP) and vascular complications. Very few studies have analyzed the association between masked HTN and markers of AS in T1D. Purpose To evaluate BP phenotypes and their associations with AS and to assess CV risk in young patients with T1D without history of HTN and other known CVD. Methods We included 81 patients with T1D without any history of known CVD. Routine clinical and laboratory evaluation was performed. Office BP was measured with a validated oscillometric device. 24-h ABPM was performed using BPLab Vasotens (“Petr Telegin”). Central BP and AS (carotid-femoral pulse wave velocity (cfPWV)) were measured with applanation tonometry. BP phenotypes were analyzed according to the criteria recommended in ESC/ESH 2018 HTN guidelines. CV risk categories were assessed with the global scale of 10-year risk (ESC 2019). P <0.05 was considered significant. Data are presented as median (interquartile range (IQR)). Results The study group included 39% males, age 27 (23; 34) years, 24.7 smokers, duration of T1D– 6 (2.8; 11) years, HbA1c – 6.9% (5.6; 7.9%). Brachial BP was 122 (110; 122)/80 (70; 80) mmHg; central BP was 109 (100; 118)/72 (67; 78) mmHg, cfPWV – 6.3 (5.3; 6.7) m/s. High and very high 10-year CV risk was observed in 87.7% of patients. True HTN was observed in 5 (6.2%) patients, masked – in 31 (38.3%), white-coat – in 1 (1.2%), true normotension in 44 (54.3%). Isolated nocturnal HTN was found in 30.7% of patients with office BP <140/90 mmHg. 41% of all patients with clinical normotension had masked HTN and isolated nocturnal HTN was present in 74.2% of them. The most common patterns of diurnal index were non-dipping (63,9%) and night-peaking (16.6%). Patients with masked HTN compared to patients with true normotension were older (31±8.6 vs 26.4±5.5 years, p=0.02), had longer duration of T1D (6 (3; 12.9) vs 4 (0.7; 8) years, p=0.009), higher urine albumin/creatinine ratio (18.5 (11; 29) vs 8 (3; 17) mg/g, p<0.001) and higher cfPWV (7.2 (6.2; 8.2) vs 6.3 (5.8; 6.8) m/s, p=0.002). Conclusions Young patients with T1D and clinical normotension are characterized by high frequency of masked HTN (41%) especially isolated nocturnal HTN (74.2%), and high rate of non-dipping. Masked HTN is associated with higher cfPWV and higher albuminuria. This may reflect early vascular changes and potentially lead to further CV risk elevation in this population. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): The publication was prepared with the support of the “RUDN University Program 5-100”

The mechanism of supply-demand imbalance and clinical outcomes in patients with type 2 myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Bularga ◽  
A Anand ◽  
F.E Strachan ◽  
K.K Lee ◽  
S Stewart ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Clinical Outcomes ◽  
Controlled Trial ◽  
Funding Source ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
Randomised Controlled

Abstract Background Type 2 myocardial infarction is common and associated with substantial risk of adverse clinical outcomes, worse than type 1 myocardial infarction, with as few as 30% of patients still alive at five years. However, this broad diagnostic term encompasses multiple mechanisms of supply-demand imbalance, which may be associated with different risks of adverse outcomes. Purpose We aimed to assess the prevalence and clinical outcomes of different mechanisms of supply-demand imbalance related to survival in the High-STEACS (High-Sensitivity Troponin in the Evaluation of patients with Acute Coronary Syndrome) randomised controlled trial. Methods The High-STEACS trial was a stepped wedge cluster randomised controlled trial in ten hospitals across Scotland, including 48,282 consecutive patients with suspected acute coronary syndrome. The diagnosis was adjudicated according to the Fourth Universal Definition of Myocardial Infarction. In patients with type 2 myocardial infarction, we prospectively adjudicated the cause for supply demand imbalance. Linkage of electronic healthcare records was used to track investigation, treatments and clinical outcomes. We used the Kaplan-Meier method, the log rank test and cox regression models adjusted for age, sex, renal function and co-morbidities to evaluate the risk of future all-cause mortality between categories. Results We identified 1,121 patients with type 2 myocardial infarction (age 74- ± 14, 55% female). At one year, death from any cause occurred in 23% (258/1,121) of patients. The most common reason for supply-demand imbalance was tachyarrhythmia in 55% (616/1,121), followed by hypoxaemia in 20% (219/1,121) of patients. Tachyarrhythmia was associated with reduced future risk of all-cause mortality (adjusted HR 0.69, 95% CI 0.43–1.09), similar to those with type 1 myocardial infarction. Comparatively, patients with hypoxaemia appeared at highest risk (adjusted HR 1.75, 95% CI 1.09–2.80). Conclusion The mechanism of myocardial oxygen supply-demand imbalance is associated with future prognosis, and should be considered when risk stratifying patients with type 2 myocardial infarction. Supply-demand imbalance survival Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation

Abstract 19569: High-sensitive Troponin T Cut-off Value for Myocardial Infarction After Vascular Surgery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Danielle M Gualandro ◽  
Gisela B Llobet ◽  
Pai C Yu ◽  
Daniela Calderaro ◽  
Andre C Marques ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Vascular Surgery ◽  
Roc Curve ◽  
Troponin T ◽  
Curve Analysis ◽  
Operating Characteristics ◽  
Roc Curve Analysis ◽  
Cutoff Value ◽  
Coronary Syndrome ◽  
High Sensitive Troponin

Introduction: Isolated high sensitive cardiac troponin T (hsTnT) elevations after vascular surgery are frequent and may lead to over diagnosis of myocardial infarction (MI). The aim of our study was to determine the accuracy of the current hsTnT cut-off value in the setting of acute coronary syndrome (ACS) after vascular surgery. Methods: Between August 2012 and March 2014, we included 337 consecutive patients submitted to arterial vascular surgery for which cardiac perioperative evaluation was requested. Perioperative surveillance included 12-lead electrocardiogram and hsTnT measurements on the three days following surgery. Patients were followed-up by cardiologists until hospital discharge and monitored for ACS. A receiver operating characteristics (ROC) curve analysis was performed to determine the hsTnT cut-off value with better accuracy for the diagnosis of perioperative ACS. Results: Of the 337 patients included, 240 (71.2%) presented hsTnT elevation above the manufacturer-provided cut-off value (0.014 ng/ml), whereas 22 (6.5%) fulfilled criteria for ACS. Median post-operative peak hsTnT of ACS patients were 0.215 ng/ml (IQR 0.043-0.493 ng/ml), versus 0.02 ng/ml (IQR 0.012-0.038 ng/ml) in patients that did not have events (P<0.001). After performing a ROC curve analysis (AUC = 0.876), we found that the manufacture-provided cutoff hsTnT value yielded a sensitivity of 100% and specificity of only 35% for diagnosis of perioperative ACS. A new hsTnT cutoff value of 0.0415 ng/ml was obtained with 86.4% sensitivity and 77% specificity for the diagnosis of perioperative ACS. Ninety-two patients (27.3%) had hsTnT elevations above the proposed new cutoff. Conclusion: A different hsTnT cutoff value of 0.0415 ng/ml is proposed and could be more useful for the diagnosis of perioperative ACS.

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