BACKGROUND: Increased cardiac troponin I or T detected by high-sensitivity assays (hs-cTnI or hs-cTnT) confers an increased risk of adverse prognosis. We determined whether patients presenting with putatively normal, detectable cTn concentrations [> limit of detection and < upper reference limit (URL)] have increased risk of major adverse cardiovascular events (MACE) or all-cause mortality. METHODS: A prospective 5-year follow-up of patients recruited in the emergency department with possible acute coronary syndrome (ACS) and cTn concentrations measured with hs-cTnI (Abbott) and hs-cTnT (Roche) assays. Cox regression models were generated with adjustment for covariates in those without MACE on presentation. Hazard ratios (HRs) for hs-cTn were calculated relative to the HRs at the median concentration. RESULTS: Of 1113 patients, 836 were without presentation MACE. Of these, 138 incurred a MACE and 169 died during a median 5.8-year follow-up. HRs for MACE at the URLs were 2.3 (95% CI, 1.7-3.2) for hs-cTnI and 1.8 (95% CI, 1.3-2.4) for hs-cTnT. Corresponding HRs for mortality were 1.7 (95% CI, 1.2-2.2) for hs-cTnI and 2.3 (95 % CI, 1.7-3.1) for hs-cTnT. The HR for MACE increased with increasing hs-cTn concentration similarly for both assays, but the HR for mortality increased at approximately twice the rate for hs-cTnT than hs-cTnI. Patients with hs-cTnI ≥10 ng/L or hs-cTnT ≥16 ng/L had the same percentage of MACE at 5-year follow-up (33%) as patients with presentation MACE. CONCLUSIONS: Many patients with ACS ruled out and putatively normal but detectable hs-cTnI concentrations are at similar long-term risk as those with MACE. hs-cTnT concentrations are more strongly associated with 5-year mortality than hs-cTnI.
BACKGROUND: Increased cardiac troponin I or T detected by high-sensitivity assays (hs-cTnI or hs-cTnT) confers an increased risk of adverse prognosis. We determined whether patients presenting with putatively normal, detectable cTn concentrations [> limit of detection and < upper reference limit (URL)] have increased risk of major adverse cardiovascular events (MACE) or all-cause mortality. METHODS: A prospective 5-year follow-up of patients recruited in the emergency department with possible acute coronary syndrome (ACS) and cTn concentrations measured with hs-cTnI (Abbott) and hs-cTnT (Roche) assays. Cox regression models were generated with adjustment for covariates in those without MACE on presentation. Hazard ratios (HRs) for hs-cTn were calculated relative to the HRs at the median concentration. RESULTS: Of 1113 patients, 836 were without presentation MACE. Of these, 138 incurred a MACE and 169 died during a median 5.8-year follow-up. HRs for MACE at the URLs were 2.3 (95% CI, 1.7-3.2) for hs-cTnI and 1.8 (95% CI, 1.3-2.4) for hs-cTnT. Corresponding HRs for mortality were 1.7 (95% CI, 1.2-2.2) for hs-cTnI and 2.3 (95 % CI, 1.7-3.1) for hs-cTnT. The HR for MACE increased with increasing hs-cTn concentration similarly for both assays, but the HR for mortality increased at approximately twice the rate for hs-cTnT than hs-cTnI. Patients with hs-cTnI ≥10 ng/L or hs-cTnT ≥16 ng/L had the same percentage of MACE at 5-year follow-up (33%) as patients with presentation MACE. CONCLUSIONS: Many patients with ACS ruled out and putatively normal but detectable hs-cTnI concentrations are at similar long-term risk as those with MACE. hs-cTnT concentrations are more strongly associated with 5-year mortality than hs-cTnI.
Authors: Yader Sandoval; Bradley R Lewis; Ramila A Mehta; Olatunde Ola; Jonathan D Knott; Laura De Michieli; Ashok Akula; Ronstan Lobo; Eric H Yang; S Michael Gharacholou; Marshall Dworak; Erika Crockford; Nicholas Rastas; Eric Grube; Swetha Karturi; Scott Wohlrab; David O Hodge; Tahir Tak; Charles Cagin; Rajiv Gulati; Allan S Jaffe Journal: Circulation Date: 2022-05-10 Impact factor: 39.918
Authors: W Frank Peacock; Alan S Maisel; Christian Mueller; Stefan D Anker; Fred S Apple; Robert H Christenson; Paul Collinson; Lori B Daniels; Deborah B Diercks; Salvatore Di Somma; Gerasimos Filippatos; Gary Headden; Brian Hiestand; Judd E Hollander; Juan C Kaski; Joshua M Kosowsky; John T Nagurney; Richard M Nowak; Donald Schreiber; Gary M Vilke; Marvin A Wayne; Martin Than Journal: Clin Exp Emerg Med Date: 2022-06-30
Authors: Peter A Kavsak; Joshua O Cerasuolo; Dennis T Ko; Jinhui Ma; Jonathan Sherbino; Shawn E Mondoux; Richard Perez; Hsien Seow; Andrew Worster Journal: CJC Open Date: 2020-03-20
Authors: Yader Sandoval; Suzette J Bielinski; Lori B Daniels; Michael J Blaha; Erin D Michos; Andrew P DeFilippis; Moyses Szklo; Christopher deFilippi; Nicholas B Larson; Paul A Decker; Allan S Jaffe Journal: J Am Coll Cardiol Date: 2020-07-28 Impact factor: 24.094
Authors: Mark Mariathas; Rick Allan; Sanjay Ramamoorthy; Bartosz Olechowski; Jonathan Hinton; Martin Azor; Zoe Nicholas; Alison Calver; Simon Corbett; Michael Mahmoudi; John Rawlins; Iain Simpson; James Wilkinson; Chun Shing Kwok; Paul Cook; Mamas A Mamas; Nick Curzen Journal: BMJ Date: 2019-03-13