scholarly journals Variation of Cardiac Troponin I and T Measured with Sensitive Assays in Emergency Department Patients with Noncardiac Chest Pain

2012 ◽  
Vol 58 (8) ◽  
pp. 1208-1214 ◽  
Author(s):  
Volkher Scharnhorst ◽  
Krisztina Krasznai ◽  
Marcel van 't Veer ◽  
Rolf H Michels
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Cardiac Troponin ◽  
Myocardial Necrosis ◽  
High Sensitivity ◽  
Noncardiac Chest Pain ◽  
Short Term ◽  
Coronary Syndrome ◽  
Concentration Changes

Abstract BACKGROUND New-generation high-sensitivity assays for cardiac troponin have lower detection limits and less imprecision than earlier assays. Reference 99th-percentile cutoff values for these new assays are also lower, leading to higher frequencies of positive test results. When cardiac troponin concentrations are minimally increased, serial testing allows discrimination of myocardial infarction from other causes of increased cardiac troponin. We assessed various measures of short-term variation, including absolute concentration changes, reference change values (RCVs), and indices of individuality (II) for 2 cardiac troponin assays in emergency department (ED) patients. METHODS We collected blood from patients presenting with cardiac chest pain upon arrival in the ED and 2, 6, and 12 h later. Cardiac troponin was measured with the high-sensitivity cardiac troponin T (hs-cTnT) assay (Roche Diagnostics) and a sensitive cTnI assay (Siemens Diagnostics). Cardiac troponin results from 67 patients without acute coronary syndrome or stable angina were used in calculating absolute changes in cardiac troponin, RCVs, and II. RESULTS The 95th percentiles for absolute change in cardiac troponin were 8.3 ng/L for hs-cTnT and 28 ng/L for cTnI. Within-individual and total CVs were 11% and 14% for hs-cTnT and 18% and 21% for cTnI, respectively. RCVs were 38% (hs-cTnT) and 57% (cTnI). The corresponding log-normal RCVs were +46%/−32% for hs-cTnT and +76%/−43% for cTnI. II values were 0.31 (cTnI) and 0.12 (hs-cTnT). CONCLUSIONS The short-term variations and IIs of cardiac troponin were low in ED patients free of ischemic myocardial necrosis. The detection of cardiac troponin variation exceeding reference thresholds can help to identify ED patients with acute myocardial necrosis whereas variation within these limits renders acute coronary syndrome unlikely.

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

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.

scholarly journals Role of High-sensitivity Cardiac Troponin in Acute Coronary Syndrome

2019 ◽  
Vol 13 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Mahesh Anantha Narayanan ◽  
Santiago Garcia
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Literature Review ◽  
Cardiac Troponin ◽  
High Sensitivity ◽  
Emergency Setting ◽  
Coronary Syndrome ◽  
The Us ◽  
Rule Out

Chest pain is one of the most common reasons for an emergency room (ER) visit in the US, with almost 6 million ER visits annually. High-sensitivity cardiac troponin (hscTn) assays have the ability to rapidly rule in or rule out acute coronary syndrome with improved sensitivity, and they are increasingly being used. Though hscTn assays have been approved for use in European, Australian, and Canadian guidelines since 2010, the FDA only approved their use in 2017. There is no consensus on how to compare the results from various hscTn assays. A literature review was performed to analyze the advantages and limitations of using hscTn as a standard biomarker to evaluate patients with suspected ACS in the emergency setting.

Rapid rule-out of suspected acute coronary syndrome in the Emergency Department by high-sensitivity cardiac troponin T levels at presentation

2018 ◽  
Vol 14 (3) ◽  
pp. 403-410 ◽  
Author(s):  
Andrea Fabbri ◽  
Cristina Bachetti ◽  
Filippo Ottani ◽  
Alice Morelli ◽  
Barbara Benazzi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Cardiac Troponin ◽  
Troponin T ◽  
High Sensitivity ◽  
Cardiac Troponin T ◽  
Coronary Syndrome ◽  
Rule Out

scholarly journals Sex-Specific Cut-Offs for High-Sensitivity Cardiac Troponin: Is Less More?

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Giulio Francesco Romiti ◽  
Roberto Cangemi ◽  
Filippo Toriello ◽  
Eleonora Ruscio ◽  
Susanna Sciomer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Cardiac Troponin ◽  
Diagnostic Performance ◽  
High Sensitivity ◽  
Current Evidence ◽  
Simplified Approach ◽  
Coronary Syndrome

Management of patients presenting to the Emergency Department with chest pain is continuously evolving. In the setting of acute coronary syndrome, the availability of high-sensitivity cardiac troponin assays (hs-cTn) has allowed for the development of algorithms aimed at rapidly assessing the risk of an ongoing myocardial infarction. However, concerns were raised about the massive application of such a simplified approach to heterogeneous real-world populations. As a result, there is a potential risk of underdiagnosis in several clusters of patients, including women, for whom a lower threshold for hs-cTn was suggested to be more appropriate. Implementation in clinical practice of sex-tailored cut-off values for hs-cTn represents a hot topic due to the need to reduce inequality and improve diagnostic performance in females. The aim of this review is to summarize current evidence on sex-specific cut-off values of hs-cTn and their application and usefulness in clinical practice. We also offer an extensive overview of thresholds reported in literature and of the mechanisms underlying such differences among sexes, suggesting possible explanations about debated issues.

PERFORMANCE OF HIGH-SENSITIVITY TROPONINS IN THE EXCLUSION OF ACUTE CORONARY SYNDROME IN PATIENTS WITH CHEST PAIN IN THE EMERGENCY DEPARTMENT

2018 ◽  
Vol 71 (11) ◽  
pp. A226
Author(s):  
Hong Jie Gabriel Tan ◽  
Swee Han Lim ◽  
Terrance Chua ◽  
Aaron Wong ◽  
Anders Olof Sahlen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
High Sensitivity ◽  
Coronary Syndrome
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