TCT-203 The Role of CT Angiography in a Management Strategy Based on High-Sensitivity Cardiac Troponin-T for Predicting an Early Prognosis in Patients With Acute Chest Pain Admitted to the Emergency Department

BACKGROUND High-sensitivity cardiac troponin assays have better analytical precision and sensitivity than earlier-generation assays when measuring cardiac troponin at low concentrations. We evaluated whether use of a high-sensitivity assay could further improve risk stratification compared with a standard cardiac troponin assay. METHODS We enrolled consecutive patients presenting with acute chest pain, 30% of whom were diagnosed with acute coronary syndrome. Blood samples were drawn at the time of presentation. We measured cardiac troponin T with a standard fourth-generation assay (cTnT) and a high-sensitivity assay (hs-cTnT) (both Roche Diagnostics) and followed the patients for 24 months. RESULTS Of the 1159 patients, 76 died and 42 developed an acute myocardial infarction (AMI). Prognostic accuracy of hs-cTnT for death was significantly higher [area under ROC curve (AUC) 0.79, 95% CI 0.74–0.84] than that of cTnT (AUC 0.69, 95% CI 0.62–0.76; P < 0.001). After adjustment for Thrombolysis in Myocardial Infarction (TIMI) risk score (that included the cTnT assay result), hs-cTnT above the 99th percentile (0.014 μg/L) was associated with a hazard ratio for death of 2.60 (95% CI 1.42–4.74). Addition of hs-cTnT to the risk score improved the reclassification of patients (net reclassification improvement 0.91; 95% CI 0.67–1.14; P < 0.001). Subgroup analyses showed that this effect resulted from the better classification of patients without AMI at time of testing. hs-cTnT outperformed cTnT in the prediction of AMI during follow-up (P=0.02), but was not independently predictive for this endpoint. CONCLUSIONS Concentrations of hs-cTnT >0.014 μg/L improve the prediction of death but not subsequent AMI in unselected patients presenting with acute chest pain.

Download Full-text

Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients

European Heart Journal ◽

10.1093/eurheartj/eht307.21 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. 21-21

Author(s):

B. Meller ◽

L. Cullen ◽

W. A. Parsonage ◽

J. Greenslade ◽

S. Aldous ◽

...

Keyword(s):

Chest Pain ◽

Cardiac Troponin ◽

Troponin T ◽

Acute Chest Pain ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Diagnostic Protocol ◽

Pain Patients

Download Full-text

Risk of revisits to the emergency department in admitted versus discharged patients with chest pain but without myocardial infarction in relation to high-sensitivity cardiac troponin T levels

International Journal of Cardiology ◽

10.1016/j.ijcard.2015.10.170 ◽

2016 ◽

Vol 203 ◽

pp. 341-346 ◽

Cited By ~ 8

Author(s):

Nadia Bandstein ◽

Rickard Ljung ◽

Martin J. Holzmann

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Chest Pain ◽

Cardiac Troponin ◽

Troponin T ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Discharged Patients

Download Full-text

Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients

International Journal of Cardiology ◽

10.1016/j.ijcard.2015.02.006 ◽

2015 ◽

Vol 184 ◽

pp. 208-215 ◽

Cited By ~ 36

Author(s):

Bernadette Meller ◽

Louise Cullen ◽

William A. Parsonage ◽

Jaimi H. Greenslade ◽

Sally Aldous ◽

...

Keyword(s):

Chest Pain ◽

Cardiac Troponin ◽

Troponin T ◽

Acute Chest Pain ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Diagnostic Protocol ◽

Pain Patients

Download Full-text

Use of historical high-sensitivity cardiac troponin T levels to rule out myocardial infarction

Open Heart ◽

10.1136/openhrt-2021-001682 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001682

Author(s):

Andreas Roos ◽

Martin J Holzmann

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Chest Pain ◽

Cardiac Troponin ◽

Troponin T ◽

High Sensitivity ◽

Cardiac Troponin T ◽

All Cause Mortality ◽

European Society Of Cardiology ◽

Rule Out

ObjectiveSeveral high-sensitivity cardiac troponin (hs-cTn)-based strategies exist for rule-out of myocardial infarction (MI). It is unknown whether historical hs-cTnT concentrations can be used. This study aim to evaluate the performance of a rule-out strategy based on the European Society of Cardiology (ESC) 0/1-hour algorithm, using historical hs-cTnT concentrations.MethodsAll visits among patients with chest pain in the emergency department at nine different hospitals in Sweden from 2012 to 2016 were eligible (221 490 visits). We enrolled patients with a 0-hour hs-cTnT of <12 ng/L, a second hs-cTnT measured within 3.5 hours, and ≥1 historical hs-cTnT available. We calculated the risks of MI and all-cause mortality using two rule-out strategies: (1) a delta hs-cTnT of <3 ng/L between the 0-hour hs-cTnT and the second hs-cTnT (modified ESC algorithm) and (2) a historical hs-cTnT <12 ng/L and a delta hs-cTnT of <3 ng/L in relation to the 0-hour hs-cTnT (historical-hs-cTnT algorithm).ResultsA total of 8432 patients were included, of whom 84 (1.0%) had an MI. The modified ESC algorithm triaged 8100 (96%) patients toward ruled-out, for whom 30-day MI risk and negative predictive value (NPV) for MI (95% CI) were 0.4% (0.3% to 0.6%) and 99.6% (99.4% to 99.7%), respectively. The historical-hs-cTnT algorithm ruled out 6700 (80%) patients, with a 30-day MI risk of 0.5% (0.4% to 0.8%) and NPV of 99.5% (99.2% to 99.6%).ConclusionsThe application of algorithm resulted in similar MI risk and NPV to an established algorithm. The usefulness of historical hs-cTnT concentrations should merit further attention.

Download Full-text