Prognostic value of undetectable hs troponin T in suspected acute coronary syndrome.
Am J Med. 2015 Oct 30;
Authors: Vafaie M, Slagman A, Möckel M, Hamm C, Huber K, Müller C, Vollert JO, Blankenberg S, Katus HA, Liebetrau C, Giannitsis E, Searle J
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 99(th) percentile, between the 99(th) 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 ≤99(th) 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 (HR=4.39; 95%-CI: 1.42-13.61; p=0.01). In patients with an initially elevated hsTnT (≥14ng/l), 9.7% (3/31) of the copeptin negative patients and 15.4% (4/26) of the copeptin positive patients experienced the combined endpoint (HR=1.61; 95%-CI: 0.36-7.17; p=0.536).
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.
PMID: 26524709 [PubMed - as supplied by publisher]