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

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Abstract

Background: 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. Methods: We compared protocols of rising and falling absolute and relative hs-cTnT changes in an unselected emergency department population. Results: A total of 635 patients with unstable angina pectoris (UAP), non-STEMI, or acute symptoms and increased hscTnT (>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. Conclusions: 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 - 2013

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Accidental Falls
Troponin T
Hospital Emergency Service
Area Under Curve
Population
Unstable Angina
Guidelines
Acute Coronary Syndrome
Biomarkers
Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Diagnostic performance of rising, falling, or rising and falling kinetic changes of high-sensitivity cardiac troponin T in an unselected emergency department population. / Biener, Moritz; Mueller, Matthias; Vafaie, Mehrshad; Jaffe, Allan S; Widera, Christian; Katus, Hugo A.; Giannitsis, Evangelos.

In: European Heart Journal: Acute Cardiovascular Care, Vol. 2, No. 4, 2013, p. 314-322.

Research output: Contribution to journalArticle

Biener, Moritz ; Mueller, Matthias ; Vafaie, Mehrshad ; Jaffe, Allan S ; Widera, Christian ; Katus, Hugo A. ; Giannitsis, Evangelos. / Diagnostic performance of rising, falling, or rising and falling kinetic changes of high-sensitivity cardiac troponin T in an unselected emergency department population. In: European Heart Journal: Acute Cardiovascular Care. 2013 ; Vol. 2, No. 4. pp. 314-322.
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abstract = "Background: 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. Methods: We compared protocols of rising and falling absolute and relative hs-cTnT changes in an unselected emergency department population. Results: A total of 635 patients with unstable angina pectoris (UAP), non-STEMI, or acute symptoms and increased hscTnT (>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. Conclusions: Detection of rising but not falling hs-cTnT values improves discrimination of non-STEMI from non-ACS in an unselected emergency department population.",
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AU - Mueller, Matthias

AU - Vafaie, Mehrshad

AU - Jaffe, Allan S

AU - Widera, Christian

AU - Katus, Hugo A.

AU - Giannitsis, Evangelos

PY - 2013

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N2 - Background: 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. Methods: We compared protocols of rising and falling absolute and relative hs-cTnT changes in an unselected emergency department population. Results: A total of 635 patients with unstable angina pectoris (UAP), non-STEMI, or acute symptoms and increased hscTnT (>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. Conclusions: Detection of rising but not falling hs-cTnT values improves discrimination of non-STEMI from non-ACS in an unselected emergency department population.

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