Predictive role of high sensitivity troponin T within four hours from presentation of acute coronary syndrome in elderly patients
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Key result
In patients 75 years or older, high-sensitivity troponin T testing within 3-4 hours yielded 88% sensitivity and 38% specificity for acute coronary syndrome, failing to safely exclude or confirm it.
Why the study?
Does high-sensitivity troponin T measurement at 0 and 3-4 hours accurately diagnose or rule out acute coronary syndrome in patients ≥ 75 years presenting with chest pain?
Population
477 consecutive patients ≥ 75 years, admitted to in-hospital care for chest pain suspicious of acute…
Design
Cohort
Follow-up
60 days
Authors
Discussion
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Implication
HsTnT may support early NSTEMI rule-out but not confirmation in elderly ED patients; leaves open optimal thresholds and protocols for ACS.
Key Points
- This study aims to assess the effectiveness of high sensitivity troponin T (HsTnT) in diagnosing acute coronary syndrome (ACS) in elderly patients within 3-4 hours of presentation.
- Retrospective analysis of 477 patients aged ≥ 75 years with chest pain suspected of ACS.
- HsTnT values were measured at presentation and again at 3-4 hours.
- Sensitivity and specificity analyses were performed using ROC curves for different HsTnT cut-off values.
- 27% of patients had ACS; 21% experienced acute myocardial infarction (AMI).
- At 3-4 hours, the standard cutoff of 14 ng/L showed sensitivity of 88% and negative predictive value (NPV) of 90% for ACS.
- Combining HsTnT at > 30 ng/L with a change > 5 ng/L yielded 99% sensitivity and 99% NPV for non-ST elevation myocardial infarction (NSTEMI).
Study Design
Type
Observational (n=477)
Multicenter
No
Structured PICO
Does high-sensitivity troponin T measurement at 0 and 3-4 hours accurately diagnose or rule out acute coronary syndrome in patients ≥ 75 years presenting with chest pain?
P
Population
477 consecutive patients aged 75 years or older admitted for suspected acute coronary syndrome, evaluated for the diagnostic performance of high-sensitivity troponin T within 3-4 hours of presentation.
E
Exposure
High-sensitivity troponin T (HsTnT) measurement at presentation (0 h) and at 3-4 h
O
Outcome
Diagnostic performance (sensitivity, specificity, negative predictive value, and positive predictive value) for acute coronary syndrome (ACS) and non-ST elevation myocardial infarction (NSTEMI)surrogate
In elderly patients (≥75 years) with chest pain, HsTnT within 3-4 hours is highly sensitive for ruling out NSTEMI but has low specificity and positive predictive value, resulting in many false positives.
Limitations
- Retrospective study performed at a single university hospital
- Only patients hospitalized following admission from the ED were included, introducing selection bias
- Incorporation bias, as HsTnT results were part of the information used to make the discharge diagnosis
- Lack of a gold standard for dynamic changes of HsTnT and diagnostic criteria for unstable angina
Cite This Study
Borna et al. (2016) conducted an observational in Suspected acute coronary syndrome (ACS) (n=477). High-sensitivity troponin T (HsTnT) testing vs. Standard clinical diagnosis was evaluated on Diagnostic performance (sensitivity and specificity) of HsTnT > 14 ng/L for ACS at 3-4 hours. In patients 75 years or older, high-sensitivity troponin T testing within 3-4 hours yielded 88% sensitivity and 38% specificity for acute coronary syndrome, failing to safely exclude or confirm it.
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