Incremental value of high-sensitivity cardiac troponin T for risk prediction in patients with suspected acute myocardial infarction
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Incremental value of high-sensitivity cardiac troponin T for risk prediction in patients with suspected acute myocardial infarction. / Hochholzer, Willibald; Reichlin, Tobias; Twerenbold, Raphael; Stelzig, Claudia; Hochholzer, Kirsten; Meissner, Julia; Haaf, Philip; Schaub, Nora; Steuer, Stephan; Bassetti, Stefano; Reiter, Miriam; Roost, Kathrin; Freidank, Heike; Winkler, Katrin; Mueller, Christian.
In: CLIN CHEM, Vol. 57, No. 9, 09.2011, p. 1318-1326.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Incremental value of high-sensitivity cardiac troponin T for risk prediction in patients with suspected acute myocardial infarction
AU - Hochholzer, Willibald
AU - Reichlin, Tobias
AU - Twerenbold, Raphael
AU - Stelzig, Claudia
AU - Hochholzer, Kirsten
AU - Meissner, Julia
AU - Haaf, Philip
AU - Schaub, Nora
AU - Steuer, Stephan
AU - Bassetti, Stefano
AU - Reiter, Miriam
AU - Roost, Kathrin
AU - Freidank, Heike
AU - Winkler, Katrin
AU - Mueller, Christian
PY - 2011/9
Y1 - 2011/9
N2 - BACKGROUND: High-sensitivity cardiac troponin assays have better analytical precision and sensitivity than earlier-generation assays when measuring cardiac troponin at low concentrations.Weevaluated whether use of a high-sensitivity assay could further improve risk stratification compared with a standard cardiac troponin assay. METHODS: We enrolled consecutive patients presenting with acute chest pain, 30% of whom were diagnosed with acute coronary syndrome. Blood samples were drawn at the time of presentation. We measured cardiac troponin T with a standard fourth-generation assay (cTnT) and a high-sensitivity assay (hs-cTnT) (both Roche Diagnostics) and followed the patients for 24 months. RESULTS: Of the 1159 patients, 76 died and 42 developed an acute myocardial infarction (AMI). Prognostic accuracy of hs-cTnT for death was significantly higher [area under ROC curve (AUC) 0.79, 95% CI 0.74-0.84] than that of cTnT (AUC 0.69, 95% CI 0.62-0.76; P<0.001). After adjustment for Thrombolysis in Myocardial Infarction (TIMI) risk score (that included the cTnT assay result), hs-cTnT above the 99th percentile (0.014 μg/L) was associated with a hazard ratio for death of 2.60 (95% CI 1.42- 4.74). Addition of hs-cTnT to the risk score improved the reclassification of patients (net reclassification improvement 0.91; 95% CI 0.67-1.14; P < 0.001). Subgroup analyses showed that this effect resulted from the better classification of patients without AMI at time of testing. hs-cTnT outperformed cTnT in the prediction of AMI during follow-up (P = 0.02), but was not independently predictive for this endpoint. CONCLUSIONS: Concentrations of hs-cTnT >0.014 μg/L improve the prediction of death but not subsequent AMI in unselected patients presenting with acute chest pain.
AB - BACKGROUND: High-sensitivity cardiac troponin assays have better analytical precision and sensitivity than earlier-generation assays when measuring cardiac troponin at low concentrations.Weevaluated whether use of a high-sensitivity assay could further improve risk stratification compared with a standard cardiac troponin assay. METHODS: We enrolled consecutive patients presenting with acute chest pain, 30% of whom were diagnosed with acute coronary syndrome. Blood samples were drawn at the time of presentation. We measured cardiac troponin T with a standard fourth-generation assay (cTnT) and a high-sensitivity assay (hs-cTnT) (both Roche Diagnostics) and followed the patients for 24 months. RESULTS: Of the 1159 patients, 76 died and 42 developed an acute myocardial infarction (AMI). Prognostic accuracy of hs-cTnT for death was significantly higher [area under ROC curve (AUC) 0.79, 95% CI 0.74-0.84] than that of cTnT (AUC 0.69, 95% CI 0.62-0.76; P<0.001). After adjustment for Thrombolysis in Myocardial Infarction (TIMI) risk score (that included the cTnT assay result), hs-cTnT above the 99th percentile (0.014 μg/L) was associated with a hazard ratio for death of 2.60 (95% CI 1.42- 4.74). Addition of hs-cTnT to the risk score improved the reclassification of patients (net reclassification improvement 0.91; 95% CI 0.67-1.14; P < 0.001). Subgroup analyses showed that this effect resulted from the better classification of patients without AMI at time of testing. hs-cTnT outperformed cTnT in the prediction of AMI during follow-up (P = 0.02), but was not independently predictive for this endpoint. CONCLUSIONS: Concentrations of hs-cTnT >0.014 μg/L improve the prediction of death but not subsequent AMI in unselected patients presenting with acute chest pain.
UR - http://www.scopus.com/inward/record.url?scp=80052276440&partnerID=8YFLogxK
U2 - 10.1373/clinchem.2011.162073
DO - 10.1373/clinchem.2011.162073
M3 - SCORING: Journal article
C2 - 21771945
AN - SCOPUS:80052276440
VL - 57
SP - 1318
EP - 1326
JO - CLIN CHEM
JF - CLIN CHEM
SN - 0009-9147
IS - 9
ER -
