Determinants of high-sensitivity troponin t among patients with a noncardiac cause of chest pain
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Determinants of high-sensitivity troponin t among patients with a noncardiac cause of chest pain. / Irfan, Affan; Twerenbold, Raphael; Reiter, Miriam; Reichlin, Tobias; Stelzig, Claudia; Freese, Michael; Haaf, Philip; Hochholzer, Willibald; Steuer, Stephan; Bassetti, Stefano; Zellweger, Christa; Freidank, Heike; Peter, Federico; Campodarve, Isabel; Meune, Christophe; Mueller, Christian.
in: AM J MED, Jahrgang 125, Nr. 5, 05.2012, S. 491-498.e1.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Determinants of high-sensitivity troponin t among patients with a noncardiac cause of chest pain
AU - Irfan, Affan
AU - Twerenbold, Raphael
AU - Reiter, Miriam
AU - Reichlin, Tobias
AU - Stelzig, Claudia
AU - Freese, Michael
AU - Haaf, Philip
AU - Hochholzer, Willibald
AU - Steuer, Stephan
AU - Bassetti, Stefano
AU - Zellweger, Christa
AU - Freidank, Heike
AU - Peter, Federico
AU - Campodarve, Isabel
AU - Meune, Christophe
AU - Mueller, Christian
N1 - Funding Information: Funding: This study has been supported by research grants from the Swiss National Science Foundation , The Swiss Heart Foundation , the University Hospital Basel , Roche Diagnostics , and Siemens AG .
PY - 2012/5
Y1 - 2012/5
N2 - Background: It is unknown to what extent noncardiac causes, including renal dysfunction, may contribute to high-sensitivity cardiac troponin T levels. Methods: In an observational international multicenter study, we enrolled consecutive patients presenting with acute chest pain to the emergency department. Of 1181 patients enrolled, 572 were adjudicated by 2 independent cardiologists to have a noncardiac cause of chest pain. Multiple linear regression analyses were used to determine the important predictors of log-transformed high-sensitivity cardiac troponin T. Kaplan-Meier curve was used to assess the prognostic significance of high-sensitivity cardiac troponin T > 0.014 μg/L (99th percentile). Results: A total of 88 patients (15%) had high-sensitivity cardiac troponin T > 0.014 μg/L. Less than 50% of cardiac troponins could be explained by known cardiac or noncardiac diseases. In decreasing order of importance, age, estimated glomerular filtration rate, hypertension, previous myocardial infarction, and chronic kidney disease (adjusted r 2 0.44) emerged as significant factors in linear regression analysis to predict high-sensitivity cardiac troponin T. High-sensitivity cardiac troponin T was best explained by a linear curve with age as ≤ 0.014 μg/L. Patients with high-sensitivity cardiac troponin T levels > 0.014 μg/L were at increased risk for all-cause mortality (hazard ratio 3.0; 95% confidence interval, 0.8-10.6; P =.02) during follow-up. Conclusion: Among the known covariates, age and not renal dysfunction is the most important determinant of high-sensitivity cardiac troponin T. Because known cardiac and noncardiac factors, including renal dysfunction, explain less than 50% of high-sensitivity cardiac troponin T levels among patients with a noncardiac cause of chest pain, unknown or underestimated cardiac involvement during the acute presenting condition seems to be the major cause of elevated high-sensitivity cardiac troponin T.
AB - Background: It is unknown to what extent noncardiac causes, including renal dysfunction, may contribute to high-sensitivity cardiac troponin T levels. Methods: In an observational international multicenter study, we enrolled consecutive patients presenting with acute chest pain to the emergency department. Of 1181 patients enrolled, 572 were adjudicated by 2 independent cardiologists to have a noncardiac cause of chest pain. Multiple linear regression analyses were used to determine the important predictors of log-transformed high-sensitivity cardiac troponin T. Kaplan-Meier curve was used to assess the prognostic significance of high-sensitivity cardiac troponin T > 0.014 μg/L (99th percentile). Results: A total of 88 patients (15%) had high-sensitivity cardiac troponin T > 0.014 μg/L. Less than 50% of cardiac troponins could be explained by known cardiac or noncardiac diseases. In decreasing order of importance, age, estimated glomerular filtration rate, hypertension, previous myocardial infarction, and chronic kidney disease (adjusted r 2 0.44) emerged as significant factors in linear regression analysis to predict high-sensitivity cardiac troponin T. High-sensitivity cardiac troponin T was best explained by a linear curve with age as ≤ 0.014 μg/L. Patients with high-sensitivity cardiac troponin T levels > 0.014 μg/L were at increased risk for all-cause mortality (hazard ratio 3.0; 95% confidence interval, 0.8-10.6; P =.02) during follow-up. Conclusion: Among the known covariates, age and not renal dysfunction is the most important determinant of high-sensitivity cardiac troponin T. Because known cardiac and noncardiac factors, including renal dysfunction, explain less than 50% of high-sensitivity cardiac troponin T levels among patients with a noncardiac cause of chest pain, unknown or underestimated cardiac involvement during the acute presenting condition seems to be the major cause of elevated high-sensitivity cardiac troponin T.
KW - Age
KW - Chest pain
KW - High-sensitivity cardiac troponin
KW - Noncardiac
KW - Renal dysfunction
UR - http://www.scopus.com/inward/record.url?scp=84859517418&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2011.10.031
DO - 10.1016/j.amjmed.2011.10.031
M3 - SCORING: Journal article
C2 - 22482847
AN - SCOPUS:84859517418
VL - 125
SP - 491-498.e1
JO - AM J MED
JF - AM J MED
SN - 0002-9343
IS - 5
ER -
