Key result
A 3-h Δ hsTnT ≥7 ng/L predicts 90-day cardiac revascularization with ~54% positive predictive value.
Why the study?
High sensitive Troponin T (hsTnT) values between 14-50 ng/L challenge ACS diagnosis at the ED, prompting evaluation of the ESC 3-h Δ hsTnT approach in a clinical setting.
Does a 3-hour Δ hsTnT ≥7 ng/L predict cardiac revascularization within 90 days in patients presenting to the ED with chest pain or dyspnea and initial hsTnT 14-50 ng/L?
Cohort (n=356)
No
Does a 3-hour Δ hsTnT ≥7 ng/L predict cardiac revascularization within 90 days in patients presenting to the ED with chest pain or dyspnea and initial hsTnT 14-50 ng/L?
Absolute Event Rate: 54% vs 17%
A 3-hour Δ hsTnT ≥7 ng/L in patients with intermediate initial hsTnT values has moderate sensitivity and good negative predictive value for predicting 90-day cardiac revascularization.
May aid short-term risk stratification in intermediate hsTnT ED patients; hypothesis-generating and requires prospective validation.
Background: high sensitive Troponin T (hsTnT) values between 14−50 ng/L represent a challenge in diagnosing acute coronary syndrome (ACS) at the Emergency Department (ED). The European Society for Cardiology (ESC) recommends a second hsTnT measurement 3 h later to distinguish between ACS and other causes depending on the Δ hsTnT. Our study aims to evaluate the predictive power this approach in a clinical setting by following patients presenting at the ED with hsTnT values 14−51 ng/L. Materials and methods: patients presenting with chest pain or dyspnea and a hsTnT value between 14 and 50 ng/L at the Erasmus MC ED in 2012−2013 were included and retrospectively monitored for 90 days after initial presentation for the occurrence of a cardiac revascularization. Patient records were reviewed according to the standing protocol, which depended on the Δ hsTnT. The “event-group” consists of patients receiving cardiac revascularization within 90 days after the ED visit, whereas the “no event-group” consisted of patients without revascularization. Results: a total of 889 patients patient records were reviewed. After excluding out-of-hospital-cardia-arrests (60), non-cardiological chest pain (373) and incomplete follow-up (100), 356 patients remained for final analysis. In 207 patients, a second hsTnT was actually performed (58%). From these 207 patients, 68 (33%) had a Δ hsTnT ≥7 ng/L. In these patients, 37 (54%) experienced an event within 90 days. In the 139 patients with a Δ hsTnT < 7 ng/L, 23 (17%) presented with an event within 90 days. Conclusion: our study demonstrated a sensitivity of 62%, a specificity of 79%, a positive predicted value (PPV) of 54% and a negative predictive value (NPV) of 83% for using a 3-h Δ hsTnT ≥7 ng/L cut-off, related to risk of an event in 90 days following ED presentation.
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Jongh et al. (2022) conducted a cohort in Acute coronary syndrome (n=356). 3-h Δ hsTnT ≥7 ng/L vs. 3-h Δ hsTnT < 7 ng/L was evaluated on Cardiac revascularization within 90 days. A 3-h Δ hsTnT ≥7 ng/L predicted cardiac revascularization within 90 days with 62% sensitivity, 79% specificity, 54% positive predictive value, and 83% negative predictive value.
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