Absolute and relative kinetic changes of high-sensitivity cardiac troponin T in acute coronary syndrome and in patients with increased troponin in the absence of acute coronary syndrome

• Verfasst von: Müller-Hennessen, Matthias [VerfasserIn]
• Verfasst von: Biener, Moritz [VerfasserIn]
• Verfasst von: Vafaie, Mehrshad [VerfasserIn]
• Verfasst von: Dörr, Susanne Katharina [VerfasserIn]
• Verfasst von: Keller, Till [VerfasserIn]
• Verfasst von: Blankenberg, Stefan [VerfasserIn]
• Verfasst von: Katus, Hugo [VerfasserIn]
• Verfasst von: Giannitsis, Evangelos [VerfasserIn]
• Titel: Absolute and relative kinetic changes of high-sensitivity cardiac troponin T in acute coronary syndrome and in patients with increased troponin in the absence of acute coronary syndrome
• Verf.angabe: Matthias Mueller, Moritz Biener, Mehrshad Vafaie, Susanne Doerr, Till Keller, Stefan Blankenberg, Hugo A. Katus, Evangelos Giannitsis
• Jahr: 2012
• Jahr des Originals: 2011
• Umfang: 10 S.
• Fussnoten: Published online December 28, 2011 ; Gesehen am 08.08.2018
• Titel Quelle: Enthalten in: Clinical chemistry
• Ort Quelle: Washington, DC : American Association for Clinical Chemistry, 1955
• Jahr Quelle: 2012
• Band/Heft Quelle: 58(2012), 1, Seite 209-218
• ISSN Quelle: 1530-8561
• DOI: doi:10.1373/clinchem.2011.171827
• Datenträger: Online-Ressource
• Sprache: eng
• Bibliogr. Hinweis: Erscheint auch als : Druck-Ausgabe: Absolute and relative kinetic changes of high-sensitivity cardiac troponin T in acute coronary syndrome and in patients with increased troponin in the absence of acute coronary syndrome. - 2012
• K10plus-PPN: 1578372208

Abstract

BACKGROUND: We evaluated kinetic changes of high-sensitivity cardiac troponin T (hs-cTnT) in patients with acute coronary syndrome (ACS) and patients with hs-cTnT increases not due to ACS to rule in or rule out non-ST-segment elevation myocardial infarction (STEMI). METHODS: hs-cTnT was measured serially in consecutive patients presenting to the emergency department. Patients with ACS who had at least 2 hs-cTnT measurements within 6 h and non-ACS patients with hs-cTnT concentrations above the 99th percentile value (14 ng/L) were enrolled to compare absolute and relative kinetic changes of hs-cTnT. RESULTS: For discrimination of non-STEMI (n = 165) in the entire study population (n = 784), the absolute δ change with the ROC-optimized value of 9.2 ng/L yielded an area under the curve of 0.898 and was superior to all relative δ changes (P < 0.0001). The positive predictive value for the absolute δ change was 48.7%, whereas the negative predictive value was 96.5%. In a specific ACS population with exclusion of STEMI (n = 342), the absolute δ change with the ROC-optimized value of 6.9 ng/L yielded a positive predictive value of 82.8% and a negative predictive value of 93.0%. In comparison to the ≥20% relative δ change, the ROC-optimized absolute δ change demonstrated a significantly added value for the entire study population and for the ACS cohort (net reclassification index 0.331 and 0.499, P < 0.0001). CONCLUSIONS: Absolute δ changes appear superior to relative δ changes in discriminating non-STEMI. A rise or fall of at least 9.2 ng/L in the entire study population and 6.9 ng/L in selected ACS patients seems adequate to rule-out non-STEMI. However, δ-values are useful to rule-in non-STEMI only in a specific ACS population.