The Elevated High-Sensitivity Cardiac Troponin T Pilot: Diagnoses and Outcomes.

Autor:	Sharain K; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN., Vasile VC; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN., Sandoval Y; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN., Donato LJ; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN., Clements CM; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN., Newman JS; Department of Hospital Internal Medicine, Mayo Clinic, Rochester, MN., Karon BS; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN., Jaffe AS; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN. Electronic address: Jaffe.Allan@mayo.edu.
Jazyk:	angličtina
Zdroj:	Mayo Clinic proceedings [Mayo Clin Proc] 2021 Sep; Vol. 96 (9), pp. 2366-2375. Date of Electronic Publication: 2021 May 13.
DOI:	10.1016/j.mayocp.2021.01.027
Abstrakt:	Objective: To identify the diagnoses and outcomes associated with elevated high sensitivity cardiac troponin T (hs-cTnT) compared with the 4th-generation troponin T and to validate the Mayo Clinic hs-cTnT myocardial infarction algorithm cutoff values. Patients and Methods: Consecutive blood samples of patients presenting to the emergency department between July 2017 and August 2017, who had 4th-generation troponin T, were also analyzed using the hs-cTnT assay. Troponin T values, discharge diagnoses, comorbidities, and outcomes were assessed. In addition, analyses of sex-specific and hs-cTnT cutoff values were assessed. Results: Of 830 patients, 32% had an elevated 4th-generation troponin T, whereas 64% had elevated hs-cTnT. With serial sampling, 4th-generation troponin missed a chronic myocardial injury pattern and acute myocardial injury pattern in 64% and 16% of patients identified with hs-cTnT, respectively. Many of these "missed" patients had discharge diagnoses associated with cardiovascular disease, infection, or were postoperative. Five of the 6 patients with unstable angina ruled in for myocardial infarction. Conclusion: There were many increases in hs-cTnT that were missed by the 4th-generation cTnT assay. Most new increases are not related to acute cardiac causes. They were more consistent with chronic myocardial injury. High-sensitivity cTnT did reclassify most patients with unstable angina as having non-ST-elevation myocardial infarction. Older age, more comorbidities, and lower hemoglobin were associated with elevated hs-cTnT. Our data also support the use of our sex-specific cutoff values. (Copyright © 2021. Published by Elsevier Inc.)
Databáze:	MEDLINE
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