Patients with acute coronary syndrome and normal high-sensitivity troponin
Standard
Patients with acute coronary syndrome and normal high-sensitivity troponin. / Meune, Christophe; Balmelli, Cathrin; Twerenbold, Raphael; Reichlin, Tobias; Reiter, Miriam; Haaf, Philip; Steuer, Stephan; Bassetti, Stefano; Sakarikos, Konstantin; Campodarve, Isabel; Zellweger, Christa; Irfan, Affan; Drexler, Beatrice; Mueller, Christian.
in: AM J MED, Jahrgang 124, Nr. 12, 12.2011, S. 1151-1157.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Patients with acute coronary syndrome and normal high-sensitivity troponin
AU - Meune, Christophe
AU - Balmelli, Cathrin
AU - Twerenbold, Raphael
AU - Reichlin, Tobias
AU - Reiter, Miriam
AU - Haaf, Philip
AU - Steuer, Stephan
AU - Bassetti, Stefano
AU - Sakarikos, Konstantin
AU - Campodarve, Isabel
AU - Zellweger, Christa
AU - Irfan, Affan
AU - Drexler, Beatrice
AU - Mueller, Christian
N1 - Funding Information: Funding: This study was supported by grants from the Swiss National Science Foundation ( PP00B-102853 ), the Swiss Heart Foundation , Abbott , Roche , Siemens , and the Department of Internal Medicine , University Hospital Basel. Funding Information: Conflict of Interest: Dr Mueller reports receiving research grant support from Abbott , Brahms , Nanosphere Inc. , Roche , and Siemens , consulting fees from Abbott, and lecture fees from Abbott, Biosite, Brahms, Roche, and Siemens. Dr Reichlin has received research grants from the University of Basel and the Department of Internal Medicine , University Hospital Basel as well as speaker honoraria from Brahms and Roche. Dr Meune was supported by a grant from the Freie Akademische Gesellschaft Basel (FAG).
PY - 2011/12
Y1 - 2011/12
N2 - Background: Failure to identify patients with acute coronary syndrome (ACS) is a serious clinical problem. The incidence, characteristics, and outcome of ACS patients with normal high-sensitivity cardiac troponin T (hs-cTnT) levels at presentation are unknown. Methods: In a prospective multicenter study, hs-cTnT was determined in a blinded fashion in 1181 consecutive patients presenting with acute chest pain to the emergency department. The final diagnosis of ACS was adjudicated by 2 independent cardiologists. Patients were followed for 12 months. Results: ACS was the adjudicated diagnosis in 351 patients (30%), including 187 patients with acute myocardial infarction (AMI) and 164 patients with unstable angina (UA). At presentation, hs-cTnT was normal (<.014 ug/L) in 112 ACS patients (32%), including 11 patients (6%) with AMI and 101 patients (62%) with UA (P <.001). Multivariable analysis revealed previous statin treatment, younger age, preserved renal function, and the absence of ST deviation on the electrocardiogram as independently associated with normal hs-cTnT levels. Mortality rates in ACS patients with normal hs-cTnT level were 0.0% at 30 days, 0.0% at 90 days, and 2.0% (95% confidence interval, 0.5-7.9) at 360 days, which was significantly lower than in ACS patients with elevated hs-cTnT level at presentation (17.5% at 360 days, P <.001). Conversely, AMI rates at 360 days was higher in ACS patients with normal versus elevated hs-cTnT levels (P =.004). Conclusion: Almost one third of ACS patients have normal hs-cTnT levels at presentation, mostly patients with UA. ACS patients with normal hs-cTnT have a very low mortality, but an increased rate of AMI during the subsequent 360 days.
AB - Background: Failure to identify patients with acute coronary syndrome (ACS) is a serious clinical problem. The incidence, characteristics, and outcome of ACS patients with normal high-sensitivity cardiac troponin T (hs-cTnT) levels at presentation are unknown. Methods: In a prospective multicenter study, hs-cTnT was determined in a blinded fashion in 1181 consecutive patients presenting with acute chest pain to the emergency department. The final diagnosis of ACS was adjudicated by 2 independent cardiologists. Patients were followed for 12 months. Results: ACS was the adjudicated diagnosis in 351 patients (30%), including 187 patients with acute myocardial infarction (AMI) and 164 patients with unstable angina (UA). At presentation, hs-cTnT was normal (<.014 ug/L) in 112 ACS patients (32%), including 11 patients (6%) with AMI and 101 patients (62%) with UA (P <.001). Multivariable analysis revealed previous statin treatment, younger age, preserved renal function, and the absence of ST deviation on the electrocardiogram as independently associated with normal hs-cTnT levels. Mortality rates in ACS patients with normal hs-cTnT level were 0.0% at 30 days, 0.0% at 90 days, and 2.0% (95% confidence interval, 0.5-7.9) at 360 days, which was significantly lower than in ACS patients with elevated hs-cTnT level at presentation (17.5% at 360 days, P <.001). Conversely, AMI rates at 360 days was higher in ACS patients with normal versus elevated hs-cTnT levels (P =.004). Conclusion: Almost one third of ACS patients have normal hs-cTnT levels at presentation, mostly patients with UA. ACS patients with normal hs-cTnT have a very low mortality, but an increased rate of AMI during the subsequent 360 days.
KW - Acute coronary syndrome
KW - False negative
KW - High-sensitivity troponin
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=81855194268&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2011.07.032
DO - 10.1016/j.amjmed.2011.07.032
M3 - SCORING: Journal article
C2 - 22014790
AN - SCOPUS:81855194268
VL - 124
SP - 1151
EP - 1157
JO - AM J MED
JF - AM J MED
SN - 0002-9343
IS - 12
ER -