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

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• 作者：Mehrshad Vafaie ; MD^a ; ¹ ; Anna Slagman ; VD ; MSc^b ; ¹ ; Martin M&ouml ; ckel ; MD ; PhD^b ; Christian Hamm ; MD ; PhD^c ; ^d ; Kurt Huber ; MD ; PhD^e ; Christian M&uuml ; ller ; MD^f ; J&ouml ; rn O. Vollert ; MD ; MBA^g ; Stefan Blankenberg ; MD ; PhD^h ; Hugo A. Katus ; MD ; PhD^a ; Christoph Liebetrau ; MD^c ; Evangelos Giannitsis ; MD ; PhD^a ; ¹ ; Julia Searle ; MD ; MPH^b ; ¹ ; ^{Julia.searle@charite.de" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Acute coronary syndrome (ACS) ; Acute myocardial infarction (AMI) ; Copeptin ; High-sensitivity troponin T (hsTnT) ; Limit of detection (LoD) ; Rule-out
• 刊名：The American Journal of Medicine
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：129
• 期：3
• 页码：274-282.e2
• 全文大小：1285 K

文摘

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 (hazard ratio 4.39; 95% confidence interval, 1.42-13.61; m>Pm> = .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; m>Pm> = .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.