Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays
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Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays. / Haaf, Philip; Reichlin, Tobias; Twerenbold, Raphael; Hoeller, Rebeca; Rubini Gimenez, Maria; Zellweger, Christa; Moehring, Berit; Fischer, Catherine; Meller, Bernadette; Wildi, Karin; Freese, Michael; Stelzig, Claudia; Mosimann, Tamina; Reiter, Miriam; Mueller, Mira; Hochgruber, Thomas; Sou, Seoung Mann; Murray, Karsten; Minners, Jan; Freidank, Heike; Osswald, Stefan; Mueller, Christian.
In: EUR HEART J, Vol. 35, No. 6, 02.2014, p. 365-75.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays
AU - Haaf, Philip
AU - Reichlin, Tobias
AU - Twerenbold, Raphael
AU - Hoeller, Rebeca
AU - Rubini Gimenez, Maria
AU - Zellweger, Christa
AU - Moehring, Berit
AU - Fischer, Catherine
AU - Meller, Bernadette
AU - Wildi, Karin
AU - Freese, Michael
AU - Stelzig, Claudia
AU - Mosimann, Tamina
AU - Reiter, Miriam
AU - Mueller, Mira
AU - Hochgruber, Thomas
AU - Sou, Seoung Mann
AU - Murray, Karsten
AU - Minners, Jan
AU - Freidank, Heike
AU - Osswald, Stefan
AU - Mueller, Christian
PY - 2014/2
Y1 - 2014/2
N2 - AIMS: Several high-sensitivity cardiac troponin (hs-cTn) assays have recently been developed. It is unknown which hs-cTn provides the most accurate prognostic information and to what extent early changes in hs-cTn predict mortality.METHODS AND RESULTS: In a prospective, international multicentre study, cTn was simultaneously measured with three novel [high-sensitivity cardiac Troponin T (hs-cTnT), Roche Diagnostics; hs-cTnI, Beckman-Coulter; hs-cTnI, Siemens] and a conventional assay (cTnT, Roche Diagnostics) in a blinded fashion in 1117 unselected patients with acute chest pain. Patients were followed up 2 years regarding mortality. Eighty-two (7.3%) patients died during the follow-up. The 2-year prognostic accuracy of hs-cTn was most accurate for hs-cTnT [area under the receivers operating characteristic curve (AUC) 0.78 (95% CI: 0.73-0.83) and outperformed both hs-cTnI (Beckman-Coulter, 0.71 (95% CI: 0.65-0.77; P = 0.001 for comparison), hs-cTnI (Siemens) 0.70 (95% CI: 0.64-0.76; P < 0.001 for comparison)] and cTnT 0.67 (95% CI: 0.61-0.74; P < 0.001 for comparison). Absolute changes of hs-cTnT were more accurate than relative changes in predicting mortality, but inferior to presentation values of hs-cTnT. Combining changes of hs-cTnT within the first 6 h with their presentation values did not further improve prognostic accuracy. Similar results were obtained for both hs-cTnI assays regarding the incremental value of changes. Hs-cTn concentrations remained predictors of death in clinically challenging subgroups such as patients with pre-existing coronary artery disease, impaired renal function, and patients older than 75 years.CONCLUSION: High-sensitivity cardiac Troponin T is more accurate than hs-cTnI in the prediction of long-term mortality. Changes of hs-cTn do not seem to further improve risk stratification beyond initial presentation values.
AB - AIMS: Several high-sensitivity cardiac troponin (hs-cTn) assays have recently been developed. It is unknown which hs-cTn provides the most accurate prognostic information and to what extent early changes in hs-cTn predict mortality.METHODS AND RESULTS: In a prospective, international multicentre study, cTn was simultaneously measured with three novel [high-sensitivity cardiac Troponin T (hs-cTnT), Roche Diagnostics; hs-cTnI, Beckman-Coulter; hs-cTnI, Siemens] and a conventional assay (cTnT, Roche Diagnostics) in a blinded fashion in 1117 unselected patients with acute chest pain. Patients were followed up 2 years regarding mortality. Eighty-two (7.3%) patients died during the follow-up. The 2-year prognostic accuracy of hs-cTn was most accurate for hs-cTnT [area under the receivers operating characteristic curve (AUC) 0.78 (95% CI: 0.73-0.83) and outperformed both hs-cTnI (Beckman-Coulter, 0.71 (95% CI: 0.65-0.77; P = 0.001 for comparison), hs-cTnI (Siemens) 0.70 (95% CI: 0.64-0.76; P < 0.001 for comparison)] and cTnT 0.67 (95% CI: 0.61-0.74; P < 0.001 for comparison). Absolute changes of hs-cTnT were more accurate than relative changes in predicting mortality, but inferior to presentation values of hs-cTnT. Combining changes of hs-cTnT within the first 6 h with their presentation values did not further improve prognostic accuracy. Similar results were obtained for both hs-cTnI assays regarding the incremental value of changes. Hs-cTn concentrations remained predictors of death in clinically challenging subgroups such as patients with pre-existing coronary artery disease, impaired renal function, and patients older than 75 years.CONCLUSION: High-sensitivity cardiac Troponin T is more accurate than hs-cTnI in the prediction of long-term mortality. Changes of hs-cTn do not seem to further improve risk stratification beyond initial presentation values.
KW - Aged
KW - Angina, Unstable/diagnosis
KW - Area Under Curve
KW - Biomarkers/blood
KW - Chest Pain/etiology
KW - Creatine Kinase, MB Form/blood
KW - Female
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/diagnosis
KW - Myoglobin/blood
KW - Prognosis
KW - Prospective Studies
KW - Risk Assessment/methods
KW - Sensitivity and Specificity
KW - Troponin T/blood
U2 - 10.1093/eurheartj/eht218
DO - 10.1093/eurheartj/eht218
M3 - SCORING: Journal article
C2 - 23821402
VL - 35
SP - 365
EP - 375
JO - EUR HEART J
JF - EUR HEART J
SN - 0195-668X
IS - 6
ER -
