Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays
| Autor: | B. Meller, Miriam Reiter, Christian Mueller, Tobias Reichlin, Heike Freidank, Maria Rubini Gimenez, Seoung Mann Sou, Tamina Mosimann, Thomas Hochgruber, Karsten Murray, Mira Mueller, Catherine Fischer, Rebeca Hoeller, Michael Freese, Stefan Osswald, Karin Wildi, Berit Moehring, Jan Minners, Claudia Stelzig, Raphael Twerenbold, Philip Haaf, Christa Zellweger |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Chest Pain medicine.medical_specialty Cardiac troponin Myocardial Infarction Kaplan-Meier Estimate Roche Diagnostics Risk Assessment Sensitivity and Specificity Coronary artery disease Troponin T Troponin complex Internal medicine Acute chest pain Creatine Kinase MB Form Humans Medicine In patient Angina Unstable Prospective Studies Myocardial infarction Aged Myoglobin business.industry Middle Aged Prognosis medicine.disease 3. Good health Area Under Curve Risk stratification Cardiology Female Cardiology and Cardiovascular Medicine business Biomarkers |
| Zdroj: | European heart journal |
| Popis: | Aims Several high-sensitivity cardiac troponin (hs-cTn) assays have recently been developed. It is unknown which hs-cTn provides the most accurate prognostic information and to what extent early changes in hs-cTn predict mortality. Methods and results In a prospective, international multicentre study, cTn was simultaneously measured with three novel [high-sensitivity cardiac Troponin T (hs-cTnT), Roche Diagnostics; hs-cTnI, Beckman-Coulter; hs-cTnI, Siemens] and a conventional assay (cTnT, Roche Diagnostics) in a blinded fashion in 1117 unselected patients with acute chest pain. Patients were followed up 2 years regarding mortality. Eighty-two (7.3%) patients died during the follow-up. The 2-year prognostic accuracy of hs-cTn was most accurate for hs-cTnT [area under the receivers operating characteristic curve (AUC) 0.78 (95% CI: 0.73–0.83) and outperformed both hs-cTnI (Beckman-Coulter, 0.71 (95% CI: 0.65–0.77; P = 0.001 for comparison), hs-cTnI (Siemens) 0.70 (95% CI: 0.64–0.76; P < 0.001 for comparison)] and cTnT 0.67 (95% CI: 0.61–0.74; P < 0.001 for comparison). Absolute changes of hs-cTnT were more accurate than relative changes in predicting mortality, but inferior to presentation values of hs-cTnT. Combining changes of hs-cTnT within the first 6 h with their presentation values did not further improve prognostic accuracy. Similar results were obtained for both hs-cTnI assays regarding the incremental value of changes. Hs-cTn concentrations remained predictors of death in clinically challenging subgroups such as patients with pre-existing coronary artery disease, impaired renal function, and patients older than 75 years. Conclusion High-sensitivity cardiac Troponin T is more accurate than hs-cTnI in the prediction of long-term mortality. Changes of hs-cTn do not seem to further improve risk stratification beyond initial presentation values. |
| Databáze: | OpenAIRE |
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