Diagnostic and prognostic performance of a novel high-sensitivity cardiac troponin T assay compared to a contemporary sensitive cardiac troponin I assay in patients with acute coronary syndrome

Abstract BACKGROUND High-sensitivity assays for cardiac troponin enable more precise measurement of very low concentrations and improved diagnostic accuracy. However, the prognostic value of these measurements, particularly at low concentrations, is less well defined. METHODS We evaluated the prognostic performance of a new high-sensitivity cardiac troponin I (hs-cTnI) assay (Abbott ARCHITECT) compared with the commercial fourth generation cTnT assay in 4695 patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) from the EARLY-ACS (Early Glycoprotein IIb/IIIa Inhibition in NSTE-ACS) and SEPIA-ACS1-TIMI 42 (Otamixaban for the Treatment of Patients with NSTE-ACS) trials. The primary endpoint was cardiovascular death or new myocardial infarction (MI) at 30 days. Baseline cardiac troponin was categorized at the 99th percentile reference limit (26 ng/L for hs-cTnI; 10 ng/L for cTnT) and at sex-specific 99th percentiles for hs-cTnI. RESULTS All patients at baseline had detectable hs-cTnI compared with 94.5% with detectable cTnT. With adjustment for all other elements of the TIMI risk score, patients with hs-cTnI ≥99th percentile had a 3.7-fold higher adjusted risk of cardiovascular death or MI at 30 days relative to patients with hs-cTnI <99th percentile (9.7% vs 3.0%; odds ratio, 3.7; 95% CI, 2.3–5.7; P < 0.001). Similarly, when stratified by categories of hs-cTnI, very low concentrations demonstrated a graded association with cardiovascular death or MI (P-trend < 0.001). Use of sex-specific cutpoints did not improve prognostic performance. Patients with negative fourth generation cTnT (<10 ng/L) but hs-cTnI ≥26 ng/L were at increased risk of cardiovascular death/MI compared to those with hs-cTnI <26 ng/L (9.2% vs 2.9%, P = 0.002). CONCLUSIONS Application of this hs-cTnI assay identified a clinically relevant higher risk of recurrent events among patients with NSTE-ACS, even at very low troponin concentrations.

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The Asia-Pacific Society of Cardiology (APSC) Expert Committee Consensus Recommendations for Assessment of Suspected Acute Coronary Syndrome Using High-Sensitivity Cardiac Troponin T in the Emergency Department

Circulation Journal ◽

10.1253/circj.cj-19-0874 ◽

2020 ◽

Vol 84 (2) ◽

pp. 136-143

Author(s):

Wei Chieh Jack Tan ◽

Kenji Inoue ◽

Laila AbdelWareth ◽

Evangelos Giannitsis ◽

Sazzli Kasim ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Cardiac Troponin ◽

Troponin T ◽

High Sensitivity ◽

Asia Pacific ◽

Expert Committee ◽

Cardiac Troponin T ◽

Coronary Syndrome ◽

Recommendations For Assessment

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P3648Detailed temporal patterns of high-sensitivity-cardiac troponin I and T during long-term follow-up after acute coronary syndrome

European Heart Journal ◽

10.1093/eurheartj/ehx504.p3648 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

V.J. Van Den Berg ◽

V.A.W.M. Umans ◽

K.M. Akkerhuis ◽

R.M. Oemrawsingh ◽

F.W. Asselbergs ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Troponin ◽

Troponin I ◽

High Sensitivity ◽

Temporal Patterns ◽

Cardiac Troponin I ◽

Coronary Syndrome ◽

Long Term Follow Up

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Prognostic Value of Elevated Copeptin and High-Sensitivity Cardiac Troponin T in Patients with and without Acute Coronary Syndrome: The ConTrACS Study

Journal of Clinical Medicine ◽

10.3390/jcm9113627 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3627

Author(s):

Hanna Waldsperger ◽

Moritz Biener ◽

Kiril M. Stoyanov ◽

Mehrshad Vafaie ◽

Hugo A. Katus ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Cardiac Troponin ◽

Cox Regression ◽

Troponin T ◽

High Sensitivity ◽

Adverse Outcomes ◽

University Hospital ◽

Cardiac Troponin T ◽

Coronary Syndrome

Aims: We aimed to assess the prognostic role of copeptin in patients presenting to the emergency department with acute symptoms and increased high-sensitivity cardiac troponin T. Methods: A total of 3890 patients presenting with acute symptoms to the emergency department of Heidelberg University Hospital were assessed for increased hs-cTnT (>14 ng/L) from three cohorts: the Heidelberg Acute Coronary Syndrome (ACS) Registry (n = 2477), the BIOPS Registry (n = 320), and the ACS OMICS Registry (n = 1093). In a pooled analysis, 1956 patients remained, comprising of 1600 patients with ACS and 356 patients with non-ACS. Results: Median follow-up was 1468 days in the ACS cohort and 709 days in the non-ACS cohort. Elevated copeptin levels (>10 pmol/L) were found in 1174 patients (60.0%) in the entire cohort (58.1% in ACS and 68.5% in non-ACS, respectively) and mortality rates were significantly higher than in patients with normal copeptin levels (29.0% vs. 10.7%, p < 0.001). In a multivariate Cox regression, elevated copeptin was independently associated with all-cause death in the ACS (HR = 1.7, 1.3–2.3, p = 0.002) and non-ACS cohort (HR = 2.7, 1.4–5.0, p = 0.0018). Conclusion: Copeptin may aid in identifying patients at risk for adverse outcomes in patients with increased levels of hs-cTnT in ACS patients and in non-ACS conditions.

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