Journal article
Diagnostic and prognostic implications using age- and gender-specific cut-offs for high-sensitivity cardiac troponin T - Sub-analysis from the TRAPID-AMI study.
- Mueller-Hennessen M Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.
- Lindahl B Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
- Giannitsis E Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: evangelos_giannitsis@med.uni-heidelberg.de.
- Biener M Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.
- Vafaie M Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.
- deFilippi CR Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
- Christ M Department of Emergency and Critical Care Medicine, Community Hospital, Paracelsus Medical University, Nuremberg, Germany.
- Santalo-Bel M Semicritical Unit, Hospital de Sant Pau &, Institut d'Investigacions Biomèdiques Sant Pau, Barcelona, Spain.
- Panteghini M Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy.
- Plebani M Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy.
- Verschuren F Department of Acute Medicine, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.
- Jernberg T Department of Medicine, KarolinskaInstitutet, Huddinge, Sweden.
- French JK Liverpool Hospital, University of New South Wales, Sydney, Australia.
- Christenson RH Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States.
- Body R Central Manchester University Hospitals NHS Foundation Trust, United Kingdom.
- McCord J Henry Ford Heart and Vascular Institute, Henry Ford Health System, Detroit, MI, United States.
- Dilba P Roche Diagnostics Germany, Penzberg, Germany.
- Katus HA Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.
- Mueller C Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland.
- 2016-02-16
Published in:
- International journal of cardiology. - 2016
AMI
Age
Diagnosis
Gender
High-sensitivity cardiac Troponin T, 99th percentile
Prognosis
Age Factors
Aged
Biomarkers
Cohort Studies
Female
Follow-Up Studies
Humans
Internationality
Male
Middle Aged
Myocardial Infarction
Prognosis
Prospective Studies
Retrospective Studies
Sex Factors
Troponin T
English
OBJECTIVES
To evaluate the impact of age- and gender-specific cut-offs for high-sensitivity cardiac troponin T (hs-cTnT) compared to the general 99th percentile hs-cTnT cut-off on diagnosis and prognosis of acute myocardial infarction (AMI).
METHODS
1282 unselected patients presenting to the emergency department with suspected AMI were enrolled as part of the TRAPID-AMI study. In the present sub-analysis, reclassification of AMI diagnosis was performed by comparing the general hs-cTnT cut-off of 14ng/L to previously proposed age- and gender-dependent hs-cTnT 99th percentile cut-offs (28ng/L for ≥65years, 9ng/L for female and 15.5ng/L for male patients). Patients were further clinically adjudicated into acute coronary syndrome (ACS) and non-ACS.
RESULTS
For patients ≥65years, application of age-specified cut-offs resulted in a decrease of AMI from 29.8% to 18.3% in the entire cohort (n=557) and 54.7% to 40.9% in the ACS subcohort (n=225). Using gender-specific cut-offs, AMI-rate increased from 16.6% to 22.6% (entire cohort, n=477) and 62.6% to 71.7% (ACS subcohort, n=99) in women, whereas in men, rates decreased from 23.1% to 21.1% (entire cohort, n=805) and 48.8% to 45.9% (ACS, n=281), respectively. Age-specified cut-offs significantly reclassified patients for outcomes of 1-month and 3-month mortality in the entire and ACS cohort (14.2% net reclassification improvement, p<0.001, respectively). Contrary, no significant differences in outcomes could be found using gender-specific cut-offs.
CONCLUSIONS
While influence of gender-specific hs-cTnT cut-offs on diagnostic and prognostic reclassification was only modest in patients with suspected AMI, age-specific cut-offs showed a significant impact and may be considered for further validation.
To evaluate the impact of age- and gender-specific cut-offs for high-sensitivity cardiac troponin T (hs-cTnT) compared to the general 99th percentile hs-cTnT cut-off on diagnosis and prognosis of acute myocardial infarction (AMI).
METHODS
1282 unselected patients presenting to the emergency department with suspected AMI were enrolled as part of the TRAPID-AMI study. In the present sub-analysis, reclassification of AMI diagnosis was performed by comparing the general hs-cTnT cut-off of 14ng/L to previously proposed age- and gender-dependent hs-cTnT 99th percentile cut-offs (28ng/L for ≥65years, 9ng/L for female and 15.5ng/L for male patients). Patients were further clinically adjudicated into acute coronary syndrome (ACS) and non-ACS.
RESULTS
For patients ≥65years, application of age-specified cut-offs resulted in a decrease of AMI from 29.8% to 18.3% in the entire cohort (n=557) and 54.7% to 40.9% in the ACS subcohort (n=225). Using gender-specific cut-offs, AMI-rate increased from 16.6% to 22.6% (entire cohort, n=477) and 62.6% to 71.7% (ACS subcohort, n=99) in women, whereas in men, rates decreased from 23.1% to 21.1% (entire cohort, n=805) and 48.8% to 45.9% (ACS, n=281), respectively. Age-specified cut-offs significantly reclassified patients for outcomes of 1-month and 3-month mortality in the entire and ACS cohort (14.2% net reclassification improvement, p<0.001, respectively). Contrary, no significant differences in outcomes could be found using gender-specific cut-offs.
CONCLUSIONS
While influence of gender-specific hs-cTnT cut-offs on diagnostic and prognostic reclassification was only modest in patients with suspected AMI, age-specific cut-offs showed a significant impact and may be considered for further validation.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.ijcard.2016.01.213
- PMID 26878470
- Persistent URL
- https://folia.unifr.ch/global/documents/8867
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