Classification and risk stratification of patients with acute chest pain using a low discriminatory level of cardiac troponin T

Abstract

SummaryBackground: Cardiac troponins are the biochemical markers of choice for the evaluation of acute coronary syndromes (ACS). Using the first-generation test, most studies related adverse outcome to > 0.20 or 0.10 µg/l cardiac troponin T (cTnT) levels. With the highly sensitive and specific second-and third-generation assays, cTnT is undetectable in most healthy individuals.Hypothesis: We evaluated whether a lower cTnT level, within 24 h of admission, could indicate an increased risk of future complications.Methods: During 1998-1999, clinical data were collected in 260 patients with ACS. Cardiac troponin T was measured at arrival, and 4, 8, and 12-24 h thereafter. The maximum cTnT value was then used to assess, over a 15-month follow-up period, the cumulative risk of death or myocardial infarction (MI), as well as rates of events according to quartiles of cTnT values.Results: Patients with ≤ 0.03 µg/l cTnT levels had the lowest rate of adverse events and the best Kaplan-Meier event-free survival curve. Increasing cTnT levels were associated with stepwise increases in mortality rates and with a constant 10-fold increase in MI rates during follow-up.Conclusions: A low threshold cTnT elevation is recommended to assess the risk of ACS. All cTnT elevations > 0.03 µg/l predict a higher risk of MI during follow-up, whereas increasing values predict mortality in relation to the amount of elevation.

Biomarkers of Cardiac Injury: An Update

“…This term signifies minor, but definite myocardial necrosis that CKMB is not sensitive enough to detect. 41 It has been hypothesized that the isolated elevation of cardiac troponins may result from increased permeability of the myocyte plasma membrane and release of the 2-6% of troponin that exists in the free form in the cytosol during ischemia without cellular necrosis. Despite the fact that the exact mechanism is yet ill defined, this group of patients with ACS, having elevated troponins and a normal CKMB, has been associated with higher risk for adverse outcomes, including death, recurrent non-fatal MI, and the need for revascularization.…”

Elevated Cardiac Troponin T in Hemodialysis Patients Receiving More Intravenous Iron Sucrose

“…In addition to these findings, the total IV iron sucrose dose was also found to be the most significant independent factor for elevated cTnT in our study. [23,38] Recent publications [39,40] have recommended 0.03 ng/mL as a cut-off value for cTnT. [32,35,36] Cardiac TnT also has a predictive role in cardiovascular events in patients with moderate chronic kidney disease.…”