Prognostic Value of Undetectable hs Troponin T in Suspected Acute Coronary Syndrome - 14/02/16
Abstract |
Background |
The search for improved strategies for safe and early discharge of patients with suspected acute coronary syndrome in emergency departments is ongoing. This Biomarkers in Cardiology (BIC)-8 biomarker substudy evaluated the usefulness of high-sensitivity troponin T (hsTnT) below or above the limit of detection (LoD) in low-to-intermediate-risk patients with suspected acute coronary syndrome in the emergency department.
Methods |
Patients were categorized into hsTnT ≥ the 99th percentile, between the 99th percentile and LoD, or undetectable hsTnT (<LoD). HsTnT and copeptin were measured at admission, using a copeptin cut-off of 10 pmol/L. The primary endpoint was death and myocardial infarction within 90 days after admission.
Results |
Of 882 patients with all biomarker results, 577 (65.4%) had detectable hsTnT levels (≥LoD). Among the 305 patients (34.6%) with undetectable hsTnT, no myocardial infarctions or deaths occurred within 90 days. In patients with detectable hsTnT at admission (≥LoD but ≤99th percentile), the combined endpoint occurred in 1.5% (6/410) of the copeptin-negative patients and in 6.3% (6/96) of copeptin-positive patients within 90 days (hazard ratio 4.39; 95% confidence interval, 1.42-13.61; P = .01). In patients with an initially elevated hsTnT (≥14 ng/L), 9.7% (3/31) of the copeptin-negative patients and 15.4% (4/26) of the copeptin-positive patients experienced the combined endpoint (hazard ratio 1.61; 95% confidence interval, 0.36-7.17; P = .536).
Conclusions |
In low-to-intermediate-risk patients with suspected acute coronary syndrome, undetectable hsTnT values at admission allow a safe discharge without occurrence of death or myocardial infarction within 90 days.
El texto completo de este artículo está disponible en PDF.Keywords : Acute coronary syndrome (ACS), Acute myocardial infarction (AMI), Copeptin, High-sensitivity troponin T (hsTnT), Limit of detection (LoD), Rule-out
Esquema
| Funding: The BIC-8 main study was supported by Thermo Fisher Scientific BRAHMS GmbH, but was an investigator-initiated trial. There was no additional funding for this BIC-8 substudy. JOV is an employee of Thermo Fisher Scientific. |
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| Conflict of Interest: MV reports nonfinancial support from Roche Diagnostics and Brahms during the conduct of the study. AS reports grants from Thermo Fisher Scientific and Roche Diagnostics during the conduct of the study; grants and nonfinancial support from Thermo Fisher Scientific, and grants from Abbott Laboratories, Radiometer, Novartis, and Cardiorentis outside the submitted work. CH reports personal fees from Thermo Fisher and Roche during the conduct of the study. JS reports grants from Thermo Fisher Brahms and Roche Diagnostics during the conduct of the study; and grants from Abbott Laboratories, Radiometer, Novartis, and Cardiorentis outside the submitted work. KH has nothing to disclose. CM reports grants, personal fees, and nonfinancial support from several diagnostic companies during the conduct of the study; and grants, personal fees, and nonfinancial support from several diagnostic and therapeutic companies outside the submitted work. JOV reports personal fees from Thermo Fisher Scientific during the conduct of the study; and personal fees and nonfinancial support from Thermo Fisher Scientific outside the submitted work; JOV is Medical Director at Thermo Fisher Scientific. SB reports grants and personal fees from Abbott, Abbott Diagnostics, Bayer, Boehringer Ingelheim, SIEMENS, and Thermo Fisher; and personal fees from Astra Zeneca, Medtronic, Pfizer, Roche, SIEMENS Diagnostics, Novartis, and Roche outside the submitted work. HAK reports personal fees from Roche Diagnostics during the conduct of the study; and grants from several companies outside the submitted work; in addition, HAK has a patent cardiac troponin T assay with royalties paid. CK has nothing to disclose. EG reports personal fees from Thermo Scientific BRAHMS GmbH and Roche Diagnostics during the conduct of the study. MM reports grants and personal fees from Thermo Fisher Scientific and Roche Diagnostics during the conduct of the study; grants and personal fees from Thermo Fisher Scientific, grants from Abbott Laboratories, grants and personal fees from Radiometer, Novartis, and grants from Cardiorentis outside the submitted work. |
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| Authorship: Each of the listed authors had access to the data and a role in writing the manuscript. Specifically, the authors contributed as follows: MV, AS: Design, analysis and interpretation of data and drafting of the manuscript. EG, JS, and MM: design and interpretation of data, drafting of the manuscript and critical revision of the manuscript for important intellectual content. CH, KH, CM, JOV, SB, AHK, and CL: Interpretation of data, critical revision of the manuscript for important intellectual content. |
Vol 129 - N° 3
P. 274 - mars 2016 Regresar al número
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