Usefulness of high-sensitivity troponin T for the evaluation of patients with acute chest pain and no or minimal myocardial damage

Sanchís, Juan; Bardajı́, Alfredo; Bosch, Xavier; Loma-Osorio, Pablo; Marín, Francisco; Sánchez, Pedro L.; Núñez, Julio; Carratalá, Arturo; Barrabés, José A.

doi:10.1016/j.ahj.2012.05.015

Cited by 31 publications

(22 citation statements)

References 24 publications

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“…Fortunately, recent reports provide some guidance. Reichlin et al have validated the prognostic gradient associated with different concentration of troponin levels, hs-troponin included, while the recent study from Sanchis et al confirmed that in patients with chest pain but with low levels of h-troponin, clinical characteristics and ECG findings added significant prognostic information in patients [18,19]. As matter of course, this is very much in line with the insight provided above.…”

Section: Discussionsupporting

confidence: 69%

Classification of myocardial infarction and unstable angina: A re-assessment

Deckers

2013

International Journal of Cardiology

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Section: Discussionsupporting

confidence: 69%

Classification of myocardial infarction and unstable angina: A re-assessment

Deckers

2013

International Journal of Cardiology

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“…These patients are often discharged with a variety of clinical diagnoses such as necrosis without MI,4 myocardial injury5 or myocardial damage,6 and their prognosis is not well established. Indeed, several clinical studies have shown that the presence of high troponin levels is associated with a worse prognosis 7–9.…”

Section: Introductionmentioning

confidence: 99%

Outcomes with type 2 myocardial infarction compared with non-ischaemic myocardial injury

Cediel

González‐Del‐Hoyo

Carrasquer

et al. 2016

Heart

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Patients with type 2 MI and NIMI were older, with higher proportion of women and more comorbidities than patients with type 1 MI. Absolute mortality and the adjusted risk for all-cause mortality in both groups were significantly higher than that of patients with type 1 MI (39.7%, HR: 1.41 95% CI 1.02 to 1.94, p=0.038 and 40.0%, HR: 1.54 95% CI 1.16 to 2.04, p=0.002, respectively). Patients with type 2 MI and NIMI tended to present more readmissions due to heart failure (16.5%, HR: 1.55 95% CI 0.87 to 2.76, p=0.133 and 12.3%, HR: 1.15 95% CI 0.70 to 1.90, p=0.580) and less readmission rates due to acute coronary syndrome (ACS) than patients with type 1 MI (2.1%, HR: 0.11 95% CI 0.04 to 0.31, p<0.001 and 4.3%, HR: 0.22 95% CI 0.12 to 0.41, p<0.001), CONCLUSIONS: Patients diagnosed with type 2 MI and NIMI have higher rates of mortality and lower readmission rates for ACS compared with patients with type 1 MI.

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“…Newer high-sensitivity assays for cardiac troponin that meet these specifications have been approved for clinical use and are available in Europe and under regulatory consideration in the US. Although several highsensitivity cardiac troponin assays have been shown to improve diagnostic accuracy for ACS, the prognostic implications of testing using these assays are less well defined and will require clinical evaluation for each as-say (10,11 ). Additionally, the lower detection limits of high-sensitivity cardiac troponin assays allow for better characterization of the normal distribution of troponin concentrations in a healthy reference population.…”

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confidence: 99%

Prognostic Performance of a High-Sensitivity Cardiac Troponin I Assay in Patients with Non–ST-Elevation Acute Coronary Syndrome

et al. 2014

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BACKGROUND High-sensitivity assays for cardiac troponin enable more precise measurement of very low concentrations and improved diagnostic accuracy. However, the prognostic value of these measurements, particularly at low concentrations, is less well defined. METHODS We evaluated the prognostic performance of a new high-sensitivity cardiac troponin I (hs-cTnI) assay (Abbott ARCHITECT) compared with the commercial fourth generation cTnT assay in 4695 patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) from the EARLY-ACS (Early Glycoprotein IIb/IIIa Inhibition in NSTE-ACS) and SEPIA-ACS1-TIMI 42 (Otamixaban for the Treatment of Patients with NSTE-ACS) trials. The primary endpoint was cardiovascular death or new myocardial infarction (MI) at 30 days. Baseline cardiac troponin was categorized at the 99th percentile reference limit (26 ng/L for hs-cTnI; 10 ng/L for cTnT) and at sex-specific 99th percentiles for hs-cTnI. RESULTS All patients at baseline had detectable hs-cTnI compared with 94.5% with detectable cTnT. With adjustment for all other elements of the TIMI risk score, patients with hs-cTnI ≥99th percentile had a 3.7-fold higher adjusted risk of cardiovascular death or MI at 30 days relative to patients with hs-cTnI <99th percentile (9.7% vs 3.0%; odds ratio, 3.7; 95% CI, 2.3–5.7; P < 0.001). Similarly, when stratified by categories of hs-cTnI, very low concentrations demonstrated a graded association with cardiovascular death or MI (P-trend < 0.001). Use of sex-specific cutpoints did not improve prognostic performance. Patients with negative fourth generation cTnT (<10 ng/L) but hs-cTnI ≥26 ng/L were at increased risk of cardiovascular death/MI compared to those with hs-cTnI <26 ng/L (9.2% vs 2.9%, P = 0.002). CONCLUSIONS Application of this hs-cTnI assay identified a clinically relevant higher risk of recurrent events among patients with NSTE-ACS, even at very low troponin concentrations.

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Usefulness of high-sensitivity troponin T for the evaluation of patients with acute chest pain and no or minimal myocardial damage

Cited by 31 publications

References 24 publications

Classification of myocardial infarction and unstable angina: A re-assessment

Classification of myocardial infarction and unstable angina: A re-assessment

Outcomes with type 2 myocardial infarction compared with non-ischaemic myocardial injury

Prognostic Performance of a High-Sensitivity Cardiac Troponin I Assay in Patients with Non–ST-Elevation Acute Coronary Syndrome

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