Matthias Mueller-Hennessen1, Bertil Lindahl2, Evangelos Giannitsis3, Moritz Biener1, Mehrshad Vafaie1, Christopher R deFilippi4, Michael Christ5, Miguel Santalo-Bel6, Mauro Panteghini7, Mario Plebani8, Franck Verschuren9, Tomas Jernberg10, John K French11, Robert H Christenson12, Richard Body13, James McCord14, Peter Dilba15, Hugo A Katus1, Christian Mueller16. 1. Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany. 2. Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. 3. Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: evangelos_giannitsis@med.uni-heidelberg.de. 4. Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States. 5. Department of Emergency and Critical Care Medicine, Community Hospital, Paracelsus Medical University, Nuremberg, Germany. 6. Semicritical Unit, Hospital de Sant Pau &, Institut d'Investigacions Biomèdiques Sant Pau, Barcelona, Spain. 7. Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy. 8. Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy. 9. Department of Acute Medicine, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium. 10. Department of Medicine, KarolinskaInstitutet, Huddinge, Sweden. 11. Liverpool Hospital, University of New South Wales, Sydney, Australia. 12. Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States. 13. Central Manchester University Hospitals NHS Foundation Trust, United Kingdom. 14. Henry Ford Heart and Vascular Institute, Henry Ford Health System, Detroit, MI, United States. 15. Roche Diagnostics Germany, Penzberg, Germany. 16. Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
Abstract
OBJECTIVES: To evaluate the impact of age- and gender-specific cut-offs for high-sensitivity cardiac troponin T (hs-cTnT) compared to the general 99th percentile hs-cTnT cut-off on diagnosis and prognosis of acute myocardial infarction (AMI). METHODS: 1282 unselected patients presenting to the emergency department with suspected AMI were enrolled as part of the TRAPID-AMI study. In the present sub-analysis, reclassification of AMI diagnosis was performed by comparing the general hs-cTnT cut-off of 14ng/L to previously proposed age- and gender-dependent hs-cTnT 99th percentile cut-offs (28ng/L for ≥65years, 9ng/L for female and 15.5ng/L for male patients). Patients were further clinically adjudicated into acute coronary syndrome (ACS) and non-ACS. RESULTS: For patients ≥65years, application of age-specified cut-offs resulted in a decrease of AMI from 29.8% to 18.3% in the entire cohort (n=557) and 54.7% to 40.9% in the ACS subcohort (n=225). Using gender-specific cut-offs, AMI-rate increased from 16.6% to 22.6% (entire cohort, n=477) and 62.6% to 71.7% (ACS subcohort, n=99) in women, whereas in men, rates decreased from 23.1% to 21.1% (entire cohort, n=805) and 48.8% to 45.9% (ACS, n=281), respectively. Age-specified cut-offs significantly reclassified patients for outcomes of 1-month and 3-month mortality in the entire and ACS cohort (14.2% net reclassification improvement, p<0.001, respectively). Contrary, no significant differences in outcomes could be found using gender-specific cut-offs. CONCLUSIONS: While influence of gender-specific hs-cTnT cut-offs on diagnostic and prognostic reclassification was only modest in patients with suspected AMI, age-specific cut-offs showed a significant impact and may be considered for further validation.
OBJECTIVES: To evaluate the impact of age- and gender-specific cut-offs for high-sensitivity cardiac troponin T (hs-cTnT) compared to the general 99th percentile hs-cTnT cut-off on diagnosis and prognosis of acute myocardial infarction (AMI). METHODS: 1282 unselected patients presenting to the emergency department with suspected AMI were enrolled as part of the TRAPID-AMI study. In the present sub-analysis, reclassification of AMI diagnosis was performed by comparing the general hs-cTnT cut-off of 14ng/L to previously proposed age- and gender-dependent hs-cTnT 99th percentile cut-offs (28ng/L for ≥65years, 9ng/L for female and 15.5ng/L for male patients). Patients were further clinically adjudicated into acute coronary syndrome (ACS) and non-ACS. RESULTS: For patients ≥65years, application of age-specified cut-offs resulted in a decrease of AMI from 29.8% to 18.3% in the entire cohort (n=557) and 54.7% to 40.9% in the ACS subcohort (n=225). Using gender-specific cut-offs, AMI-rate increased from 16.6% to 22.6% (entire cohort, n=477) and 62.6% to 71.7% (ACS subcohort, n=99) in women, whereas in men, rates decreased from 23.1% to 21.1% (entire cohort, n=805) and 48.8% to 45.9% (ACS, n=281), respectively. Age-specified cut-offs significantly reclassified patients for outcomes of 1-month and 3-month mortality in the entire and ACS cohort (14.2% net reclassification improvement, p<0.001, respectively). Contrary, no significant differences in outcomes could be found using gender-specific cut-offs. CONCLUSIONS: While influence of gender-specific hs-cTnT cut-offs on diagnostic and prognostic reclassification was only modest in patients with suspected AMI, age-specific cut-offs showed a significant impact and may be considered for further validation.
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