TY - JOUR
T1 - Prognostic performance of high-sensitivity cardiac troponin T kinetic changes adjusted for elevated admission values and the GRACE score in an unselected emergency department population
AU - Biener, Moritz
AU - Mueller, Matthias
AU - Vafaie, Mehrshad
AU - Jaffe, Allan S.
AU - Katus, Hugo A.
AU - Giannitsis, Evangelos
PY - 2014/8/5
Y1 - 2014/8/5
N2 - Purpose: The aim of this study was to test the prognostic performance of rising and falling kinetic changes of high-sensitivity cardiac troponin T (hs-cTnT) and the GRACE score. Methods: Rising and falling hs-cTnT changes in an unselected emergency department population were compared. Results: 635 patients with a hs-cTnT >. 99th percentile admission value were enrolled. Of these, 572 patients qualified for evaluation with rising patterns (n=254, 44.4%), falling patterns (n=224, 39.2%), or falling patterns following an initial rise (n=94, 16.4%). During 407. days of follow-up, we observed 74 deaths, 17 recurrent AMI, and 79 subjects with a composite of death/AMI. Admission values >. 14. ng/L were associated with a higher rate of adverse outcomes (OR, 95%CI:death:12.6, 1.8-92.1, p=0.01, death/AMI:6.7, 1.6-27.9, p=0.01). Neither rising nor falling changes increased the AUC of baseline values (AUC: rising 0.562 vs. 0.561, p=ns, falling: 0.533 vs. 0.575, p=ns). A GRACE score ≥. 140 points indicated a higher risk of death (OR, 95%CI: 3.14, 1.84-5.36), AMI (OR, 95%CI: 1.56, 0.59-4.17), or death/AMI (OR, 95%CI: 2.49, 1.51-4.11). Hs-cTnT changes did not improve the prognostic performance of a GRACE score ≥. 140 points (AUC, 95%CI: death: 0.635, 0.570-0.701 vs. 0.560, 0.470-0.649 p=ns, AMI: 0.555, 0.418-0.693 vs. 0.603, 0.424-0.782, p=ns, death/AMI: 0.610, 0.545-0.676 vs. 0.538, 0.454-0.622, p=ns). Coronary angiography was performed earlier in patients with rising than with falling kinetics (median, IQR [hours]:13.7, 5.5-28.0 vs. 20.8, 6.3-59.0, p=0.01). Conclusion: Neither rising nor falling hs-cTnT changes improve the prognostic performance of elevated hs-cTnT admission values or the GRACE score. However, rising values are more likely associated with the decision for earlier invasive strategy.
AB - Purpose: The aim of this study was to test the prognostic performance of rising and falling kinetic changes of high-sensitivity cardiac troponin T (hs-cTnT) and the GRACE score. Methods: Rising and falling hs-cTnT changes in an unselected emergency department population were compared. Results: 635 patients with a hs-cTnT >. 99th percentile admission value were enrolled. Of these, 572 patients qualified for evaluation with rising patterns (n=254, 44.4%), falling patterns (n=224, 39.2%), or falling patterns following an initial rise (n=94, 16.4%). During 407. days of follow-up, we observed 74 deaths, 17 recurrent AMI, and 79 subjects with a composite of death/AMI. Admission values >. 14. ng/L were associated with a higher rate of adverse outcomes (OR, 95%CI:death:12.6, 1.8-92.1, p=0.01, death/AMI:6.7, 1.6-27.9, p=0.01). Neither rising nor falling changes increased the AUC of baseline values (AUC: rising 0.562 vs. 0.561, p=ns, falling: 0.533 vs. 0.575, p=ns). A GRACE score ≥. 140 points indicated a higher risk of death (OR, 95%CI: 3.14, 1.84-5.36), AMI (OR, 95%CI: 1.56, 0.59-4.17), or death/AMI (OR, 95%CI: 2.49, 1.51-4.11). Hs-cTnT changes did not improve the prognostic performance of a GRACE score ≥. 140 points (AUC, 95%CI: death: 0.635, 0.570-0.701 vs. 0.560, 0.470-0.649 p=ns, AMI: 0.555, 0.418-0.693 vs. 0.603, 0.424-0.782, p=ns, death/AMI: 0.610, 0.545-0.676 vs. 0.538, 0.454-0.622, p=ns). Coronary angiography was performed earlier in patients with rising than with falling kinetics (median, IQR [hours]:13.7, 5.5-28.0 vs. 20.8, 6.3-59.0, p=0.01). Conclusion: Neither rising nor falling hs-cTnT changes improve the prognostic performance of elevated hs-cTnT admission values or the GRACE score. However, rising values are more likely associated with the decision for earlier invasive strategy.
KW - GRACE score
KW - High-sensitivity troponin T
KW - Kinetic changes
KW - Prognosis
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U2 - 10.1016/j.cca.2014.04.007
DO - 10.1016/j.cca.2014.04.007
M3 - Article
AN - SCOPUS:84899997392
SN - 0009-8981
VL - 435
SP - 29
EP - 35
JO - Clinica Chimica Acta
JF - Clinica Chimica Acta
ER -