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Am J Med. 2016 Mar;129(3):274-82.e2. doi: 10.1016/j.amjmed.2015.10.016. Epub 2015 Oct 30.

Prognostic Value of Undetectable hs Troponin T in Suspected Acute Coronary Syndrome.

Author information

1
Department of Angiology, Cardiology and Pneumology, University Hospital of Heidelberg, Heidelberg, Germany.
2
Department of Cardiology, Division of Emergency Medicine, Charité Universitätsmedizin Berlin (Campus Virchow Klinikum and Campus Charité Mitte), Berlin, Germany.
3
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany; Medical Clinic I, Cardiology and Angiology, University of Giessen, Giessen, Germany.
4
Department of Cardiology and Internal Emergency Medicine, Wilhelminenspital, Vienna, Austria.
5
Department of Cardiology, University Hospital Basel, Switzerland.
6
Clinical Diagnostics, Thermo Fisher Scientific, B.R.A.H.M.S GmbH, Hennigsdorf, Germany.
7
Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany.
8
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany.
9
Department of Cardiology, Division of Emergency Medicine, Charité Universitätsmedizin Berlin (Campus Virchow Klinikum and Campus Charité Mitte), Berlin, Germany. Electronic address: Julia.searle@charite.de.

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.

KEYWORDS:

Acute coronary syndrome (ACS); Acute myocardial infarction (AMI); Copeptin; High-sensitivity troponin T (hsTnT); Limit of detection (LoD); Rule-out

PMID:
26524709
DOI:
10.1016/j.amjmed.2015.10.016
[Indexed for MEDLINE]

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