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A single high-sensitive cardiac troponin (hs-cTn) can be used to rule-out acute myocardial infarction (MI) in patients presenting >3 hours (3 h) after chest pain onset to the emergency department. This study aimed to investigate the safety of ruling-out MI in early presenters with chest pain ≤3 h using a single hs-cTnI at admission. We prospectively enrolled patients presenting with chest pain suggestive of MI. Hs-cTnI (Siemens ADVIA Centaur TNIH, Limit of detection: 2.2 ng/L) was measured at admission. Two physicians adjudicated final diagnosis. A diagnostic cut-off value <3 ng/L was used to rule-out MI. Patients were classified as early (chest pain ≤3 h) or late presenters (>3 h). We included 1370 patients with available admission hs-cTnI results: median (Q1–Q3) age 65 (52–74), female sex: 43%, previous MI: 22%. We confirmed MI in 118 (8.6%) patients. Overall, 470 (34%) patients were classified as early, 770 (56%) as late presenters, and 130 (9%) patients had unknown onset. When applying the diagnostic cut-off value, MI was correctly ruled-out at admission in 370 (27%) patients: 134 (29%) early presenters, 206 (27%) late presenters and 30 (23%) patients with unknown onset. This resulted in an overall negative predictive value of 100% (95% CI: 99.0–100%), with both 100% (97.3–100%) for early and 100% (98.2–100%) for late presenters, respectively. Sensitivity was similarly high in the two groups. MI could be safely ruled-out in all patients presenting with chest pain ≤3 h when using a single hs-cTnI value <3 ng/L as diagnostic cut-off. NCT03634384. [Display omitted] • A single troponin measurement may be used to rule-out myocardial infarction (MI). • Rule-out of MI was highly safe in late presenters, i.e. presentation >3 h. • Early presenters with MI had lower troponin values than late presenters. • However, rule-out of MI was equally safe in early presenters. • No patients with MI were missed when using a single-testing algorithm at admission. [ABSTRACT FROM AUTHOR]

Aim: Expected 1‐year survival is essential to risk stratification of patients with heart failure (HF); however, little is known about the 1‐year prognosis of patients with HF and cancer. Thus, the objective was to investigate the 1‐year prognosis following new‐onset HF stratified by cancer status in patients with breast, gastrointestinal, or lung cancer. Methods and results: All Danish patients with new‐onset HF from 2000 to 2018 were included. Cancer status was categorized as history of cancer (no cancer‐related contact within 5 years of HF diagnosis), non‐active cancer (curative intended procedure administered) and active cancer. Standardized 1‐year all‐cause mortality was reported using G‐computation. Age‐stratified 1‐year all‐cause mortality was estimated using the Kaplan–Meier estimator. In total, 193 359 patients with HF were included, 7.3% had either a breast, gastrointestinal, or lung cancer diagnosis. Patients with cancer were older and more comorbid than patients without cancer. Standardized 1‐year all‐cause mortality (95% confidence intervals) was 24.6% (23.0–26.2%), 27.1% (25.5–28.6%), and 29.9% (25.9–34.0%) for history of breast, gastrointestinal and lung cancer, respectively, which was comparable to patients with non‐active cancers. For active breast, gastrointestinal and lung cancer, standardized 1‐year all‐cause mortality was 36.2% (33.8–38.6%), 49.0% (47.2–50.9%), and 61.6% (59.7–63.5%), respectively. One‐year all‐cause mortality increased incrementally with age, except for active lung cancer. Conclusion: Standardized 1‐year all‐cause mortality was comparable for patients with history of cancer and non‐active cancer regardless of cancer type, but varied comprehensively for active cancers. Prognostic impact of age was limited for active lung cancer. Thus, granular stratification of cancer is necessary for optimized management of new‐onset HF. [ABSTRACT FROM AUTHOR]

Pulmonary embolism (PE) is described as a prognostic factor in patients with cancer however, the prognostic impact of PE remains unknown. This study investigated, the 1-year prognosis following PE in patients with breast-, gastrointestinal-, or lung cancer stratified by cancer status. All Danish patients with first-time PE from 2008 to 2018 were included. Cancer status was categorized as no cancer, history of cancer, non-active cancer and active cancer. Unadjusted and age-stratified 1-year risk of death was estimated using the Kaplan-Meier estimator. Cause of death was reported using the Aalen-Johansen method. Of 35,679 patients with PE, 18% had a breast-, gastrointestinal-, or lung cancer. Patients with cancer were older compared with no cancer (69.8 years [IQR: 56.2–79.8]). One-year risk of death (95% confidence interval) for active breast-, gastrointestinal-, and lung cancer was 49.5% (44.0%–54.9%), 75.0% (72.5%–77.4%) and 80.1% (78.0%–82.3%) respectively, compared with 18.9% (18.4%–19.3%) for no cancer. Age-stratified analysis revealed no association with increasing age in non-active lung cancer and all active cancers. Further, non-cardiovascular death accounted for an increasing proportion by cancer status (no cancer < history of cancer < non-active cancer < active cancer). One-year risk of death was dependent on both cancer type and status; no association with age was found for patients with active cancers. Non-cardiovascular death was leading in non-active and active cancers. Thus, the occurrence of first-time PE could be regarded as a marker of cancer severity for patients with breast-, gastrointestinal-, and lung cancer. [Display omitted] • An increasing incidence of pulmonary embolism was found in patients with breast-, gastrointestinal- or lung cancer over the past decade. • The 1-year prognosis of pulmonary embolism was highly dependent on both cancer type and status in patients with breast-, gastrointestinal- or lung cancer. • The leading cause of death in patients with non-active and active breast-, gastrointestinal- or lung cancer was non-cardiovascular disease. • Increasing age had limited impact on the 1-year prognosis in patients with active breast-, gastrointestinal- and lung cancer. [ABSTRACT FROM AUTHOR]