Cardiac troponin T concentrations above the 99th percentile value as measured by a new high-sensitivity assay predict long-term prognosis in patients with acute coronary syndromes undergoing routine early invasive strategy

Celik, Sultan; Giannitsis, Evangelos; Wollert, Kai C.; Schwöbel, K.; Loßnitzer, Dirk; Hilbel, Thomas; Lehrke, Stephanie; Zdunek, Dietmar; Hess, Alexis E.; Januzzi, James L.; Katus, Hugo A.

doi:10.1007/s00392-011-0344-x

Cited by 43 publications

(28 citation statements)

References 30 publications

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“…With the utilization of hs‐Tn assays, early identification of high risk will affect choices for medical and invasive therapies. Potential benefits of early risk stratification with hs‐Tn assays may include targeting early invasive treatment, utilization of early adjunctive medical therapy (eg, low‐molecular‐weight heparin, upstream IIb/IIIa inhibition), and decisions about early discharge. However, the optimal management of these patients with Tn elevations previously undetectable with older assays will need to be further studied.…”

Section: Discussionmentioning

confidence: 99%

Use of High‐Sensitivity Troponin Assays Predicts Mortality in Patients With Normal Conventional Troponin Assays on Admission—Insights From a Meta‐Analysis

Chatterjee

Kim

Dahhan

et al. 2013

Clinical Cardiology

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Background: Use of high-sensitivity troponin (hs-Tn) assays can detect small levels of myocardial damage previously undetectable with conventional troponin (c-Tn) assays. However, prognostic utility of these hs-Tn assays in prediction of mortality remains unclear in the presence of nonelevated c-Tn levels on admission. A systematic review and meta-analysis was performed to assess mortality risk of patients with hs-Tn elevations in the setting of normal c-Tn levels. Hypothesis: Patients with hs-Tn elevations with normal c-Tn levels on admission blood samples, drawn to rule out acute coronary syndrome (ACS), have a higher mortality risk than those without hs-Tn or c-Tn elevations. Methods: A search was made of the PubMed, CENTRAL, EMBASE, CINAHL, EBSCO, and Web of Science databases. Studies evaluating patients with suspected ACS that reported mortality rates for those with elevated hs-Tn levels but normal c-Tn levels on admission were included. A random-effects model was used to pool event rates, and data were reported in odds ratios (95% confidence interval). Results: Four studies (N = 2033, mean age 64-75 years, 49%-70% male) revealed that nearly 32% of suspected ACS patients with normal c-Tn levels on admission had elevated hs-Tn levels. Elevated hs-Tn levels conferred a significantly higher risk of all-cause mortality vs normal hs-Tn levels (odds ratio: 4.35, 95% confidence interval: 2.81-6.73, P < 0.01), with negligible heterogeneity (I 2 = 0%). Conclusions: Elevation of hs-Tn levels predicted a higher risk of mortality in patients with suspected ACS and may aid in the early identification of higher-risk patients in this setting. Future studies are needed to investigate further optimal management strategies.

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Section: Discussionmentioning

confidence: 99%

Use of High‐Sensitivity Troponin Assays Predicts Mortality in Patients With Normal Conventional Troponin Assays on Admission—Insights From a Meta‐Analysis

Chatterjee

Kim

Dahhan

et al. 2013

Clinical Cardiology

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“…Therefore, our patient population is not representative of patients with chest pain seen in an outpatient scenario. Secondly, the broader use of highly sensitive cardiac troponin—compared to that used in this study—would detect more NSTEMIs [19, 22, 23]. As these next-generation assays can measure up to tenfold lower troponin concentrations than conventional assays [20], we might have obtained higher sensitivity levels if we had used such assays in this study cohort.…”

Section: Discussionmentioning

confidence: 99%

Cardiogoniometry as a diagnostic tool in patients with acute coronary syndromes: results of the CGM@ACS trial

et al. 2012

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BackgroundCardiogoniometry (CGM) is a novel electrocardiac method utilising computer-assisted three-dimensional information on cardiac potentials.ObjectiveTo investigate the potential of CGM in discriminating non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and relevant coronary stenosis upon hospital admission by prospectively comparing its sensitivity, specificity and accuracy against those of a single troponin test and a 12-lead ECG performed on admissionDesignA multicenter prospective observational trial.SettingEight interventional cardiac centres in Germany.PatientsA cohort of 216 patients (mean age 67 years, 34.7 % female) who presented with acute chest pain or dyspnoea without ST-segment elevation and were scheduled for coronary angiography within 72 h of admission.InterventionPre-angiography screening by CGM, troponin test, 12-lead ECGMain outcome measuresECG, troponin and CGM on admission compared with final diagnosis of NSTE-ACS or relevant diameter stenosis ≥70 % verified by an independent review board and an angiographic core laboratory.ResultsNSTE-ACS was finally confirmed in 162 cases, whereas the remaining 54 cases without proof of NSTE-ACS served as controls. Diagnostic sensitivity for NSTE-ACS was 28, 50 and 69 % and specificity 78, 96 and 54 % for first ECG, serial troponin and first CGM, respectively. Accuracy was 40, 62 and 65 %. The sensitivity of the tests to detect relevant coronary stenosis (n = 126) was 32, 53 and 74 %, respectively. The sensitivity of CGM to detect NSTE-ACS (65 %) or relevant stenosis (71 %) was high even in patients with normal troponin and ECG.ConclusionsCGM can detect NSTE-ACS at first medical contact. CGM in conjunction with traditional markers, 12-lead ECG and troponin may effectively aid early decision making in patients presenting with acute chest pain.

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“…Nowadays measurement of cardiac damage markers is established as a standard diagnostic procedure for acute coronary syndrome. 2 In addition, these markers are elevated in stable patients and also have mortality prognostic value. 3,4 However, only a few studies have evaluated the relation Hazard ratio -Exp (B), CI -95% confidence interval of Exp (B), p-significance of coeff.…”

Section: Discussionmentioning

confidence: 99%

“…1 In non-uremic patients with suspected myocardial damage determination of myoglobin, creatinine kinase MB (CK-MB) and troponins has been shown to be reliable for early diagnosis of myocardial damage and risk stratifications, as well as in stable coronary artery disease patients. [2][3][4] However, in hemodialysis patients these markers are elevated and diagnosis of myocardial injury based on them is less reliable. 5 In addition, reasons for their elevation are complex and due rather to chronic cell injury than to decreased clearance.…”

Section: Introductionmentioning

confidence: 99%

A comparison of markers of myocardial injury and their relation to nutritional parameters in hemodialysis patients

Stošović¹,

Stanković²,

Stanojević³

et al. 2014

Renal Failure

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Background: Serum cardiac troponin T (cTnT) is a valuable marker of ischemic heart disease (IHD) and left ventricular hypertrophy, as well as a mortality predictor in hemodialysis populations. We compared the value of cTnT, creatinine kinase (CK)-MB mass and myoglobin as mortality predictors in our hemodialysis patients and evaluated their relation to nutritional status. Methods: A total of 118 hemodialysis patients were prospectively studied from January 2004 to April 2013. Clinical and laboratory evaluations during the 12-month baseline period included the history of IHD, signs of left ventricular hypertrophy (LVH), Kt/V and serum cardiac markers together with the percentage of body fat (%fat), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), triceps skinfold (TSF) and BMI. Results: Underweight patients had significantly higher cTnT values (Mann-Whitney, p50.05). Correlation analysis (Spearman) showed an inverse association between cTnT and TSF ( ¼ À0.22, p50.05), as well as between CK-MB mass and TSF ( ¼ À0.26, p50.01). In men cTnT also correlated inversely with %fat ( ¼ À0.27, p50.05) and BMI ( ¼ À0.33, p50.05). In addition, myoglobin was correlated significantly with MAC, MAMC and albumin. Among cardiac markers cTnT was the only independent variable predicting mortality (Multivariate Cox regression, HR ¼ 1.04 CI (1.01-1.07); p50.01; measurement units 0.01 mg/L). Conclusion: Troponin T and CK-MB mass were significantly elevated in the underweight patient group. Troponin T was the only independent cardiac marker predictor of all cause mortality in our hemodialysis patients.

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Cardiac troponin T concentrations above the 99th percentile value as measured by a new high-sensitivity assay predict long-term prognosis in patients with acute coronary syndromes undergoing routine early invasive strategy

Abstract: hsTnT at the 99th percentile cutoff is useful for the diagnostic evaluation of patients with ACS, and provides strong and independent predictive power for adverse long-term outcomes even after early invasive strategy.

Cited by 43 publications

References 30 publications

Use of High‐Sensitivity Troponin Assays Predicts Mortality in Patients With Normal Conventional Troponin Assays on Admission—Insights From a Meta‐Analysis

Use of High‐Sensitivity Troponin Assays Predicts Mortality in Patients With Normal Conventional Troponin Assays on Admission—Insights From a Meta‐Analysis

Cardiogoniometry as a diagnostic tool in patients with acute coronary syndromes: results of the CGM@ACS trial

A comparison of markers of myocardial injury and their relation to nutritional parameters in hemodialysis patients

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