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

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

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)29-35
Number of pages7
JournalClinica Chimica Acta
Volume435
DOIs
StatePublished - Aug 5 2014

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Troponin T
Accidental Falls
Hospital Emergency Service
Kinetics
Population
Area Under Curve
Angiography
Coronary Angiography
Composite materials

Keywords

  • GRACE score
  • High-sensitivity troponin T
  • Kinetic changes
  • Prognosis

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

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

In: Clinica Chimica Acta, Vol. 435, 05.08.2014, p. 29-35.

Research output: Contribution to journalArticle

@article{dcae3732cf3a47efa0a02dd8f0a27d17,
title = "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",
abstract = "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.",
keywords = "GRACE score, High-sensitivity troponin T, Kinetic changes, Prognosis",
author = "Moritz Biener and Matthias Mueller and Mehrshad Vafaie and Jaffe, {Allan S} and Katus, {Hugo A.} and Evangelos Giannitsis",
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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

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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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