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. 2021 Mar 25:34:100758.
doi: 10.1016/j.ijcha.2021.100758. eCollection 2021 Jun.

Comparing conventional and high sensitivity troponin T measurements in identifying adverse cardiac events in patients admitted to an Asian emergency department chest pain observation unit

Ziwei Lin  1 , Swee Han Lim  2 , Qai Ven Yap  3 , Carol Hui Chen Tan  4 , Yiong Huak Chan  3 , Hung Chew Wong  3 , E Shyong Tai  5 , Arthur Mark Richards  6   7   8 , Terrance Siang Jin Chua  9
Affiliations

Comparing conventional and high sensitivity troponin T measurements in identifying adverse cardiac events in patients admitted to an Asian emergency department chest pain observation unit

Ziwei Lin et al. Int J Cardiol Heart Vasc. .

Abstract

Background: High sensitive cardiac troponin assays can be used for prediction of major adverse cardiac events (MACE) in patients with chest pain.

Methods: We included patients with symptoms suggestive of acute coronary syndrome in the emergency department observation unit. We compared the accuracy of conventional troponin T (cTnT) with high sensitive troponin T (hsTnT) at various ranges, as well as the utility of hsTnT and cTnT in prediction of 30-day and 1-year MACE.

Results: 1023 patients were included (68.1% male, median age 56 years). There were 2712 hsTnT and cTnT values compared. hsTnT had a higher AUC than cTnT for 30-day and 1-year MACE. The optimal cut-off of 0-hour hsTnT for 30-day (PPV 34%, NPV 96.6%) and 1-year MACE (PPV 40.2%, NPV 94.2%) was 16 ng/L.For 844 patients who had values for both 0 and 2 h hsTnT, we proposed a rule-out cut-off of 0 and 2 h hsTnT < 16 ng/L (NPV 97.0%, 95%CI 95.5-98.1%) and a rule-in cut-off of 0 and 2 h hsTnT ≥ 26 ng/L (PPV 58.8%, 95%CI 40.7%-75.4%) for 30-day MACE. Negative 0-2 h delta-hsTnT had poor predictive discriminant capabilities on 30-day (PPV 8.2%) and 1-year MACE (PPV 12.3%).

Conclusion: The cut off values of hsTnT used in the 0 and 2-hour algorithm to rule-out (16 ng/L) and rule-in MACE (26 ng/L) are in the range that previous cTnT assays are unable to measure accurately. Risk scores can be used to further improve NPV of the rule-out group. A fall in hsTnT level acutely is not predictive of MACE.

Keywords: Acute coronary syndrome; Biomarkers; Chest pain; Major adverse cardiac events; Myocardial infarction; Troponin.

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Conflict of interest statement

Dr. Arthur M. Richards has received, in kind, support from the industry: assay provision by Roche Diagnostics and Abbott Laboratories; research grant from Roche Diagnostics; and speaker’s and advisory board fees from Roche Diagnostics and Novartis.

Figures

Fig. 1.1
Fig. 1.1
cTnT versus hsTnT for cTnT values of 100 ng/L and above.
Fig. 1.2
Fig. 1.2
cTnT versus hsTnT for cTnT values of 10 ng/L to 99 ng/L.
Fig. 2
Fig. 2
ROC curves for 0-hour hsTnT cut-offs versus 30-day and 1-year MACE.
Fig. 31
Fig. 31
Trend of PPV and NPV for 0, 2, and 7 h hsTnT and 0–2 h delta-hsTnT cut-offs for 30-day MACE.
Fig. 32
Fig. 32
Trend of PPV and NPV for 0, 2, and 7 h hsTnT and 0–2 h delta-hsTnT cut-offs for 1-year MACE.
Fig. 4
Fig. 4
Proposed rule-in and rule-out cut-offs for 30-day and 1-year MACE.
See this image and copyright information in PMC

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