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Title:

Comparison of prognostic value of high-sensitivity and conventional troponin T in patients with non-ST-segment elevation acute coronary syndromes.

Document type:
Comparative Study; Journal Article
Author(s):
Ndrepepa, G; Braun, S; Schulz, S; Byrne, RA; Pache, J; Mehilli, J; Schömig, A; Kastrati, A
Abstract:
The impact of high-sensitivity troponin assays on risk stratification of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is unknown.The study included 447 patients with NSTE-ACS. Cardiac troponin T (TnT) was measured with conventional and high-sensitivity assays, in parallel, using the same plasma sample. The primary end-point was 4-year mortality.The use of cut-off of 0.014 ?g/L of high-sensitivity TnT (hs-TnT) instead of 0.01 ?g/L of the conventional (cTnT) increased proportion of non-ST-segment elevation myocardial infarction (NSTEMI) patients by 33% (from 201 to 268 patients). Re-classified patients from unstable angina to NSTEMI had similar 4-year mortality compared to patients with NSTEMI by both assays: 16 deaths (25.1%) among 67 re-classified patients versus 47 deaths (23.6%) among patients diagnosed with NSTEMI by both assays; odds ratio=1.03, 95% confidence interval [CI] 0.53-1.97; P=0.933). The Cox model identified hsTnT (hazard ratio=2.59, 95% CI 1.22-5.50; P=0.013 for hsTnT>0.014?g/L versus hsTnT <= 0.014 ?g/L) as an independent correlate of 4-year mortality. hsTnT significantly improved prediction of the four-year mortality (relative integrated discrimination improvement 8.2%, P=0.005).The use of hsTnT instead of cTnT increased the proportion of patients with NSTEMI among patients with NSTE-ACS and significantly improved risk stratification regarding long-term mortality.
Journal title abbreviation:
Clin Chim Acta
Year:
2011
Journal volume:
412
Journal issue:
15-16
Pages contribution:
1350-6
Language:
eng
Fulltext / DOI:
doi:10.1016/j.cca.2011.03.037
Pubmed ID:
http://view.ncbi.nlm.nih.gov/pubmed/21497154
Print-ISSN:
0009-8981
TUM Institution:
I. Medizinische Klinik und Poliklinik (Kardiologie); Institut für Laboratoriumsmedizin (keine SAP-Zuordnung!)
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