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Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays

Haaf, Philip ; Reichlin, Tobias ; Twerenbold, Raphael ; Hoeller, Rebeca ; Rubini Gimenez, Maria ; Zellweger, Christa ; Moehring, Berit ; Fischer, Catherine ; Meller, Bernadette ; Wildi, Karin ; Freese, Michael ; Stelzig, Claudia ; Mosimann, Tamina ; Reiter, Miriam ; Mueller, Mira ; Hochgruber, Thomas ; Sou, Seoung Mann ; Murray, Karsten ; Minners, Jan ; Freidank, Heike ; Osswald, Stefan ; Mueller, Christian

In: European Heart Journal, 2014, vol. 35, no. 6, p. 365-375

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    Titel
    • Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays
    Autor
    • Haaf, Philip. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Reichlin, Tobias. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Twerenbold, Raphael. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Hoeller, Rebeca. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Rubini Gimenez, Maria. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Zellweger, Christa. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Moehring, Berit. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Fischer, Catherine. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Meller, Bernadette. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Wildi, Karin. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Freese, Michael. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Stelzig, Claudia. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Mosimann, Tamina. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Reiter, Miriam. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Mueller, Mira. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Hochgruber, Thomas. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Sou, Seoung Mann. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Murray, Karsten. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Minners, Jan. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Freidank, Heike. Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
    • Osswald, Stefan. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    • Mueller, Christian. Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • European Heart Journal, 2014, vol. 35, no. 6, p. 365-375. Oxford University Press
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:297826
    Summary
    Aims Several high-sensitivity cardiac troponin (hs-cTn) assays have recently been developed. It is unknown which hs-cTn provides the most accurate prognostic information and to what extent early changes in hs-cTn predict mortality. Methods and results In a prospective, international multicentre study, cTn was simultaneously measured with three novel [high-sensitivity cardiac Troponin T (hs-cTnT), Roche Diagnostics; hs-cTnI, Beckman-Coulter; hs-cTnI, Siemens] and a conventional assay (cTnT, Roche Diagnostics) in a blinded fashion in 1117 unselected patients with acute chest pain. Patients were followed up 2 years regarding mortality. Eighty-two (7.3%) patients died during the follow-up. The 2-year prognostic accuracy of hs-cTn was most accurate for hs-cTnT [area under the receivers operating characteristic curve (AUC) 0.78 (95% CI: 0.73-0.83) and outperformed both hs-cTnI (Beckman-Coulter, 0.71 (95% CI: 0.65-0.77; P = 0.001 for comparison), hs-cTnI (Siemens) 0.70 (95% CI: 0.64-0.76; P < 0.001 for comparison)] and cTnT 0.67 (95% CI: 0.61-0.74; P < 0.001 for comparison). Absolute changes of hs-cTnT were more accurate than relative changes in predicting mortality, but inferior to presentation values of hs-cTnT. Combining changes of hs-cTnT within the first 6 h with their presentation values did not further improve prognostic accuracy. Similar results were obtained for both hs-cTnI assays regarding the incremental value of changes. Hs-cTn concentrations remained predictors of death in clinically challenging subgroups such as patients with pre-existing coronary artery disease, impaired renal function, and patients older than 75 years. Conclusion High-sensitivity cardiac Troponin T is more accurate than hs-cTnI in the prediction of long-term mortality. Changes of hs-cTn do not seem to further improve risk stratification beyond initial presentation values