Efficacy of High-Sensitivity Troponin T in Identifying Very-Low-Risk Patients With Possible Acute Coronary Syndrome

Peacock, W. Frank; Baumann, Brigette M.; Bruton, D.; Davis, Thomas E.; Handy, Beverly Carol; Jones, Christopher W.; Hollander, Judd E.; Limkakeng, Alexander T.; Mehrotra, Abhi; Than, Martin; Ziegler, André; Dinkel, Carina

doi:10.1001/jamacardio.2017.4625

Cited by 102 publications

(78 citation statements)

References 31 publications

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“…If AMI is suspected, the diagnosis can be defined further using a variety of serum markers, which include creatine kinase (CK) and its subclasses (CKMB), and troponin (both I and T). Troponin T is an independent prognostic indicator of adverse outcomes and can be used as a patient risk‐stratifying tool . Elevation of troponin in CS may identify patients who present late.…”

Section: Domains Of Patient Characteristicsmentioning

confidence: 99%

SCAI clinical expert consensus statement on the classification of cardiogenic shock

Baran

Grines

Bailey

et al. 2019

Cathet Cardio Intervent

780

358

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Background The outcome of cardiogenic shock complicating myocardial infarction has not appreciably changed in the last 30 years despite the development of various percutaneous mechanical circulatory support options. It is clear that there are varying degrees of cardiogenic shock but there is no robust classification scheme to categorize this disease state. Methods A multidisciplinary group of experts convened by the Society for Cardiovascular Angiography and Interventions was assembled to derive a proposed classification schema for cardiogenic shock. Representatives from cardiology (interventional, advanced heart failure, noninvasive), emergency medicine, critical care, and cardiac nursing all collaborated to develop the proposed schema. Results A system describing stages of cardiogenic shock from A to E was developed. Stage A is “at risk” for cardiogenic shock, stage B is “beginning” shock, stage C is “classic” cardiogenic shock, stage D is “deteriorating”, and E is “extremis”. The difference between stages B and C is the presence of hypoperfusion which is present in stages C and higher. Stage D implies that the initial set of interventions chosen have not restored stability and adequate perfusion despite at least 30 minutes of observation and stage E is the patient in extremis, highly unstable, often with cardiovascular collapse. Conclusion This proposed classification system is simple, clinically applicable across the care spectrum from pre‐hospital providers to intensive care staff but will require future validation studies to assess its utility and potential prognostic implications.

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Section: Domains Of Patient Characteristicsmentioning

confidence: 99%

SCAI clinical expert consensus statement on the classification of cardiogenic shock

Baran

Grines

Bailey

et al. 2019

Cathet Cardio Intervent

780

358

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“…A prospective, observational study46 on 1600 patients with suspected ACS at 15 emergency departments in the USA demonstrated that a single hsTnT level less than 6 ng/L at baseline had a NPV for acute myocardial infarction of 99.4%, and the NPV for 30-day acute coronary events was 99.3% when both 0 hour and 3 hour hsTnT levels were 19 ng/L or less.…”

Section: Introductionmentioning

confidence: 99%

Troponins: established and novel indications in the management of cardiovascular disease

Giannitsis

Katus

2018

Heart

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“…Values of cardiac biomarkers were greater in patients who experienced the primary outcome (hscTnT, median [IQR] = 22 [10-51] ng/mL vs. 11 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] ng/mL; NT-proBNP median [IQR] = 776 [244-2,175] ng/mL vs. 210 [82-620] ng/mL). Table 1 and Data Supplement S1, Figures S1 and S2 (available as supporting information in the online version of this paper, which is available at http://onlinelibrary.wiley.com/doi/10.1111/acem.…”

Section: Resultsmentioning

confidence: 99%

“…The hscTnT assay used was the Roche Elecsys Gen 5 STAT, which has a lower detectable limit of 5 ng/L and a U.S. reference 99th percentile cutoff limit of 19 ng/L for hscTnT. 17 The NT-proBNP assay used was the Roche Elecys 2010 Cobas, with recommended use of a 125 ng/L lower limit of normal for patients under 75 years and 450 ng/L for patients over 75 years. We report both.…”

Section: Independent Predictors and Covariatesmentioning

confidence: 99%

Do High‐sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?

Clark

Gibson

Weiss

et al. 2019

Academic Emergency Medicine

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Objectives: An estimated 1.2 million annual emergency department (ED) visits for syncope/near syncope occur in the United States. Cardiac biomarkers are frequently obtained during the ED evaluation, but the prognostic value of index high-sensitivity troponin (hscTnT) and natriuretic peptide (NT-proBNP) are unclear. The objective of this study was to determine if hscTnT and NT-proBNP drawn in the ED are independently associated with 30-day death/serious cardiac outcomes in adult patients presenting with syncope.Methods: A prespecified secondary analysis of a prospective, observational trial enrolling participants ≥ age 60 presenting with syncope, at 11 United States hospitals, was conducted between April 2013 and September 2016. Exclusions included seizure, stroke, transient ischemic attack, trauma, intoxication, hypoglycemia, persistent confusion, mechanical/electrical invention, prior enrollment, or predicted poor follow-up. Within 3 hours of consent, hscTnT and NT-proBNP were collected and later analyzed centrally using Roche Elecsys Gen 5 STAT and 2010 Cobas, respectively. Primary outcome was combined 30-day all-cause mortality and serious cardiac events. Adjusting for illness severity, using multivariate logistic regression analysis, variations between primary outcome and biomarkers were estimated, adjusting absolute risk associated with ranges of biomarkers using Bayesian Markov Chain Monte Carlo methods.Results: The cohort included 3,392 patients; 367 (10.8%) experienced the primary outcome. Adjusted absolute risk for the primary outcome increased with hscTnT and NT-proBNP levels. HscTnT levels ≤ 5 ng/L were associated with a 4% (95% confidence interval [CI] = 3%-5%) outcome risk, and hscTnT > 50 ng/L, a 29% (95% CI = 26%-33%) risk. NT-proBNP levels ≤ 125 ng/L were associated with a 4% (95% CI = 4%-5%) risk, and NT-proBNP > 2,000 ng/L a 29% (95% CI = 25%-32%) risk. Likelihood ratios and predictive values demonstrated similar results. Sensitivity analyses excluding ED index serious outcomes demonstrated similar findings.Conclusions: hscTnT and NT-proBNP are independent predictors of 30-day death and serious outcomes in older ED patients presenting with syncope.From the

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Efficacy of High-Sensitivity Troponin T in Identifying Very-Low-Risk Patients With Possible Acute Coronary Syndrome

Abstract: A single hsTnT level less than 6 ng/L was associated with a markedly decreased risk of AMI, while serial levels at 19 ng/L or less identified patients at less than 1% risk of 30-day ACE.

Cited by 102 publications

References 31 publications

SCAI clinical expert consensus statement on the classification of cardiogenic shock

SCAI clinical expert consensus statement on the classification of cardiogenic shock

Troponins: established and novel indications in the management of cardiovascular disease

Do High‐sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?

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