Performance of a Multiplier Score of the 99th Percentile of Troponin Level to Predict In-Hospital Events and one-year Mortality in Acute Coronary Syndrome

pp. 25-30

Abstract

Background: In Argentina, high-sensitivity troponin is widely used to evaluate patients with chest pain. However, variability between assays (troponin I or T) and their different cut-off points and percentiles may hinder uniform interpretation.
Objective: This study assessed the performance of a multiplier score based on the 99th percentile of troponin level to predict in-hospital and one-year mortality, as well as ischemic and bleeding events in patients with acute coronary syndrome (ACS).
Methods: We used the ReSCAR registry, a prospective multicenter study that included patients with ACS. A total of 917 cases were analyzed: 291 with troponin I measurement and 626 with troponin T measurement. The multiplier score was calculated as the ratio of the troponin concentration to the 99th percentile of the corresponding assay. The area under the ROC curve (AUC ROC) of this score was evaluated regarding its ability to predict in-hospital ischemic and bleeding events, as well as in-hospital mortality and mortality at one-year follow-up.
Results: In-hospital mortality was 3.9%, while at one-year mortality was 7.2%. In-hospital ischemic events occurred in 8.2% of patients and bleeding events in 2.9%. The median score was 5.4 (IQR 1.2-48.2). The AUC ROC of the score to predict ischemic events was 0.64. No significant differences were observed when compared to the GRACE score (0.67). For bleeding events, the AUC ROC curve of the score was 0.63, comparable to that of the CRUSADE score (0.64). The discriminative ability of the score to predict in-hospital and one-year mortality was lower than that of the GRACE score (0.59 vs. 0.77 and 0.62 vs. 0.79, p <0.01 for both).
Conclusion: The multiplier score based on the 99th percentile of troponin level is a simple and potentially useful tool for standardizing risk assessment in different centers which have diverse laboratories. Although its performance to predict in-hospital ischemic and bleeding events is comparable to that of the GRACE and CRUSADE scores, it showed lower accuracy to predict mortality.

Cómo citar este artículo

Kersten S, Sigal AR, Rivero M, Furmento JF, Conde D, Meza M, y cols. Performance of a Multiplier Score of the 99th Percentile of Troponin Level to Predict In-Hospital Events and one-year Mortality in Acute Coronary Syndrome. Rev Argent Cardiol 2025;93:25-30. https://doi.org/10.7775/rac.v93.i1.20852