Diagnostic performance of rising, falling, or rising and falling kinetic changes of high-sensitivity cardiac troponin T in an unselected emergency department population

Moritz Biener, Matthias Mueller, Mehrshad Vafaie, Allan S. Jaffe, Christian Widera, Hugo A. Katus, Evangelos Giannitsis

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Current ESC guidelines for the diagnosis of myocardial infarction consider a rise and/or fall of cardiac biomarkers. However, whether rising or falling patterns of high-sensitivity cardiac troponin T (hs-cTnT) improve the discrimination of ST-elevation myocardial infarction (non-STEMI) from non-acute coronary syndromes (ACS) has not been evaluated yet. We compared protocols of rising and falling absolute and relative hs-cTnT changes in an unselected emergency department population. A total of 635 patients with unstable angina pectoris (UAP), non-STEMI, or acute symptoms and increased hs-cTnT (99th percentile) were enrolled. Of these, 572 patients met the inclusion criteria of consistently rising patterns (n=254, 44.4%), consistently falling patterns (n=224, 39.2%), or falling patterns after an initial rise (n=94, 16.4%). Final diagnoses included 66 (11.5%) patients with UAP, 141 (24.7%) patients with non-STEMI, and 365 (63.8%) patients with hs-cTnT elevations not due to ACS. Rising values were found more frequently in patients with non-STEMI, as compared to non-ACS (OR 3.69, 95% CI 2.46–5.53; p<0.0001), and falling patterns were observed more frequently in patients with non-ACS conditions (OR 3.56, 95% CI 2.24–5.63; p<0.001). Addition of rising but not falling changes increased diagnostic performance of hs-cTnT concentrations at presentation: positive: AUC 0.680 (95% CI 0.618–0.742) vs. 0.861 (95% CI 0.822–0.900; p<0.0001), negative: AUC 0.678 (95% CI 0.545–0.812) vs. 0.741 (95% CI 0.635–0.847). A 20% criterion as proposed by ESC guidelines performed equally for positive and negative changes only when admission hs-cTnT values were considered: AUC 0.785 (95% CI 0.726–0.845) vs. AUC 0.763 (95% CI 0.681–0.845); p=ns. Detection of rising but not falling hs-cTnT values improves discrimination of non-STEMI from non-ACS in an unselected emergency department population.

Original languageEnglish (US)
Pages (from-to)314-322
Number of pages9
JournalEuropean Heart Journal: Acute Cardiovascular Care
Volume2
Issue number4
DOIs
StatePublished - Dec 2013

Keywords

  • Diagnostic performance
  • high-sensitivity troponin T
  • negative changes
  • non-STEMI
  • positive changes

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Diagnostic performance of rising, falling, or rising and falling kinetic changes of high-sensitivity cardiac troponin T in an unselected emergency department population'. Together they form a unique fingerprint.

  • Cite this