Effect of Acute Coronary Syndrome Probability on Diagnostic and Prognostic Performance of High-Sensitivity Cardiac Troponin
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Effect of Acute Coronary Syndrome Probability on Diagnostic and Prognostic Performance of High-Sensitivity Cardiac Troponin. / Badertscher, Patrick; Boeddinghaus, Jasper; Nestelberger, Thomas; Twerenbold, Raphael; Wildi, Karin; Sabti, Zaid; Puelacher, Christian; Rubini Giménez, Maria; Pfäffli, Julian; Flores, Dayana; du Fay de Lavallaz, Jeanne; Miró, Òscar; Martin-Sanchez, F Javier; Morawiec, Beata; Lohrmann, Jens; Buser, Andreas; Keller, Dagmar I; Geigy, Nicolas; Reichlin, Tobias; Mueller, Christian.
In: CLIN CHEM, Vol. 64, No. 3, 03.2018, p. 515-525.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Effect of Acute Coronary Syndrome Probability on Diagnostic and Prognostic Performance of High-Sensitivity Cardiac Troponin
AU - Badertscher, Patrick
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Twerenbold, Raphael
AU - Wildi, Karin
AU - Sabti, Zaid
AU - Puelacher, Christian
AU - Rubini Giménez, Maria
AU - Pfäffli, Julian
AU - Flores, Dayana
AU - du Fay de Lavallaz, Jeanne
AU - Miró, Òscar
AU - Martin-Sanchez, F Javier
AU - Morawiec, Beata
AU - Lohrmann, Jens
AU - Buser, Andreas
AU - Keller, Dagmar I
AU - Geigy, Nicolas
AU - Reichlin, Tobias
AU - Mueller, Christian
N1 - © 2017 American Association for Clinical Chemistry.
PY - 2018/3
Y1 - 2018/3
N2 - BACKGROUND: There is concern that high-sensitivity cardiac troponin (hs-cTn) may have low diagnostic accuracy in patients with low acute coronary syndrome (ACS) probability.METHODS: We prospectively stratified patients presenting with acute chest discomfort to the emergency department (ED) into 3 groups according to their probability for ACS as assessed by the treating ED physician using a visual analog scale: ≤10%, 11% to 79%, and ≥80%, reviewing all information available at 90 min. hs-cTnT and hs-cTnI concentrations were determined in a blinded fashion. Two independent cardiologists adjudicated the final diagnosis.RESULTS: Among 3828 patients eligible for analysis, 1189 patients had low (≤10%) probability for ACS. The incidence of non-ST-segment elevation myocardial infarction (NSTEMI) increased from 1.3% to 12.2% and 54.8% in patients with low, intermediate, and high ACS probability, respectively. The positive predictive value of hs-cTnT and hs-cTnI was low in patients with low ACS probability and increased with the incidence of NSTEMI, whereas the diagnostic accuracy of hs-cTnT and hs-cTnI for NSTEMI as quantified by the area under the curve (AUC) was very high and comparable among all 3 strata, e.g., AUC hs-cTnI, 0.96 (95% CI, 0.94-0.97); 0.87 (95% CI, 0.85-0.89); and 0.89 (95% CI, 0.87-0.92), respectively. Findings were validated using bootstrap analysis as an alternative methodology to define ACS probability. Similarly, higher hs-cTnT/I concentrations independently predicted all-cause mortality within 2 years (e.g., hs-cTnT hazard ratio, 1.39; 95% CI, 1.27-1.52), irrespective of ACS probability.CONCLUSIONS: Diagnostic and prognostic accuracy and utility of hs-cTnT and hs-cTnI remain high in patients with acute chest discomfort and low ACS probability.ClinicalTrials.gov Identifier: NCT00470587.
AB - BACKGROUND: There is concern that high-sensitivity cardiac troponin (hs-cTn) may have low diagnostic accuracy in patients with low acute coronary syndrome (ACS) probability.METHODS: We prospectively stratified patients presenting with acute chest discomfort to the emergency department (ED) into 3 groups according to their probability for ACS as assessed by the treating ED physician using a visual analog scale: ≤10%, 11% to 79%, and ≥80%, reviewing all information available at 90 min. hs-cTnT and hs-cTnI concentrations were determined in a blinded fashion. Two independent cardiologists adjudicated the final diagnosis.RESULTS: Among 3828 patients eligible for analysis, 1189 patients had low (≤10%) probability for ACS. The incidence of non-ST-segment elevation myocardial infarction (NSTEMI) increased from 1.3% to 12.2% and 54.8% in patients with low, intermediate, and high ACS probability, respectively. The positive predictive value of hs-cTnT and hs-cTnI was low in patients with low ACS probability and increased with the incidence of NSTEMI, whereas the diagnostic accuracy of hs-cTnT and hs-cTnI for NSTEMI as quantified by the area under the curve (AUC) was very high and comparable among all 3 strata, e.g., AUC hs-cTnI, 0.96 (95% CI, 0.94-0.97); 0.87 (95% CI, 0.85-0.89); and 0.89 (95% CI, 0.87-0.92), respectively. Findings were validated using bootstrap analysis as an alternative methodology to define ACS probability. Similarly, higher hs-cTnT/I concentrations independently predicted all-cause mortality within 2 years (e.g., hs-cTnT hazard ratio, 1.39; 95% CI, 1.27-1.52), irrespective of ACS probability.CONCLUSIONS: Diagnostic and prognostic accuracy and utility of hs-cTnT and hs-cTnI remain high in patients with acute chest discomfort and low ACS probability.ClinicalTrials.gov Identifier: NCT00470587.
KW - Acute Coronary Syndrome/blood
KW - Adult
KW - Aged
KW - Biomarkers/blood
KW - Female
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/blood
KW - Probability
KW - Sensitivity and Specificity
KW - Troponin I/blood
KW - Troponin T/blood
U2 - 10.1373/clinchem.2017.279513
DO - 10.1373/clinchem.2017.279513
M3 - SCORING: Journal article
C2 - 29343534
VL - 64
SP - 515
EP - 525
JO - CLIN CHEM
JF - CLIN CHEM
SN - 0009-9147
IS - 3
ER -
