Axel C Carlsson1, Nadia Bandstein2, Andreas Roos2, Ola Hammarsten3, Martin J Holzmann4. 1. Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden. 2. Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Solna, Stockholm, Sweden. 3. Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 4. Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Solna, Stockholm, Sweden. Electronic address: martin.holzmann@karolinska.se.
Abstract
BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) was recently introduced into clinical practice. The increased sensitivity has decreased the specificity. We aimed to determine the predictors for and prevalence of hs-cTnT levels above the 99th percentile in a stable population of patients without myocardial infarction (MI) who sought medical attention for chest pain in the emergency department. METHODS: We included 11,847 patients with chest pain and at least one hs-cTnT measurement during 2011 and 2012. Patients with any acute reasons for an elevated hs-cTnT level were excluded. We used logistic regression to calculate adjusted odds ratios with 95% confidence intervals for the association between patient characteristics and hs-cTnT levels of >14ng/L. We also determined 50th, 75th, 97.5th, and 99th percentile values of hs-cTnT levels in relation to age, sex, estimated glomerular filtration rate (eGFR), and presence or absence of comorbidities. RESULTS: In total, 1360 (11%) patients had hs-cTnT levels of >14ng/L. Men had higher troponin levels than women, and older patients had higher levels than younger patients. The strongest predictor of an elevated troponin level was a reduced eGFR. The 99th percentile for hs-cTnT among all men and among women <50years of age with normal renal function was 20 and 12ng/L, respectively; this level increased to 44 and 36ng/L, respectively, at the age of 70-79years. CONCLUSIONS: A hs-cTnT level above the 99th percentile in patients with chest pain but no MI is common and is related to sex, age, and eGFR.
BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) was recently introduced into clinical practice. The increased sensitivity has decreased the specificity. We aimed to determine the predictors for and prevalence of hs-cTnT levels above the 99th percentile in a stable population of patients without myocardial infarction (MI) who sought medical attention for chest pain in the emergency department. METHODS: We included 11,847 patients with chest pain and at least one hs-cTnT measurement during 2011 and 2012. Patients with any acute reasons for an elevated hs-cTnT level were excluded. We used logistic regression to calculate adjusted odds ratios with 95% confidence intervals for the association between patient characteristics and hs-cTnT levels of >14ng/L. We also determined 50th, 75th, 97.5th, and 99th percentile values of hs-cTnT levels in relation to age, sex, estimated glomerular filtration rate (eGFR), and presence or absence of comorbidities. RESULTS: In total, 1360 (11%) patients had hs-cTnT levels of >14ng/L. Men had higher troponin levels than women, and older patients had higher levels than younger patients. The strongest predictor of an elevated troponin level was a reduced eGFR. The 99th percentile for hs-cTnT among all men and among women <50years of age with normal renal function was 20 and 12ng/L, respectively; this level increased to 44 and 36ng/L, respectively, at the age of 70-79years. CONCLUSIONS: A hs-cTnT level above the 99th percentile in patients with chest pain but no MI is common and is related to sex, age, and eGFR.
Authors: Matthew T H Lowry; Dimitrios Doudesis; Ryan Wereski; Dorien M Kimenai; Christopher Tuck; Amy V Ferry; Anda Bularga; Caelan Taggart; Kuan K Lee; Andrew R Chapman; Anoop S V Shah; David E Newby; Nicholas L Mills; Atul Anand Journal: Circulation Date: 2022-09-15 Impact factor: 39.918
Authors: Axel C Carlsson; Toralph Ruge; Erik Kjøller; Jørgen Hilden; Hans Jørn Kolmos; Ahmad Sajadieh; Jens Kastrup; Gorm Boje Jensen; Anders Larsson; Christoph Nowak; Janus Christian Jakobsen; Per Winkel; Christian Gluud; Johan Ärnlöv Journal: J Am Heart Assoc Date: 2018-04-23 Impact factor: 5.501