High sensitivity troponin outperforms contemporary assays in predicting major adverse cardiac events up to two years in patients with chest pain
Key result
High-sensitivity troponin T outperformed contemporary troponin T for predicting 2-year MACE in patients with suspected acute coronary syndromes (AUC 0.70 vs 0.61; P=0.001).
Why the study?
Does high-sensitivity troponin T improve the prediction of major adverse cardiac events compared to contemporary troponin assays in patients with suspected acute coronary syndromes?
Population
332 patients with suspected acute coronary syndromes (ACS) presenting with chest pain
Comparison
High-sensitivity troponin T assay vs Contemporary troponin assays
Design
Cohort
Follow-up
two years
Authors
Discussion
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Member takes
Implication
hs-Troponin may offer superior MACE prediction versus contemporary assays in suspected ACS; leaves open whether it should alter management.
Key Points
- This research aims to evaluate the prognostic effectiveness of high-sensitivity troponin versus contemporary troponin assays in patients with suspected acute coronary syndromes.
- Included 332 patients with suspected acute coronary syndrome followed for two years.
- Compared Roche Elecsys high-sensitivity troponin T, Abbott Architect troponin I 3rd generation, and Roche Elecsys troponin T.
- Analyzed blood samples for predictive value regarding major adverse cardiovascular events.
- 68 patients (20.5%) experienced major adverse cardiovascular events within two years.
- Area under the ROC curve for hsTnT was 0.70 (95% CI: 0.63-0.76), superior to TnT (0.61) and TnI 3 (0.66).
- Cumulative event rates for hsTnT were 35.6% for levels ≥99th percentile, contrasting with 17.9% for levels between LOD and 99th percentile, and 5.4% for levels <LOD.
Study Design
Type
Cohort (n=332)
Structured PICO
Does high-sensitivity troponin T improve the prediction of major adverse cardiac events compared to contemporary troponin assays in patients with suspected acute coronary syndromes?
P
Population
332 patients with suspected acute coronary syndromes followed for two years.
E
Exposure
High-sensitivity troponin T assay (Roche Elecsys hsTnT)
C
Comparator
Contemporary troponin assays (Abbott Architect troponin I 3rd generation [TnI 3] and Roche Elecsys troponin T [TnT])
O
Outcome
Major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and revascularization at two yearscomposite
Main Result
Effect estimate: AUC 0.70 (95% CI 0.63-0.76)
p-value: p=0.001
High-sensitivity troponin T provides superior prognostic stratification for 2-year major adverse cardiac events compared to contemporary troponin assays in patients with suspected ACS, particularly identifying a very low-risk cohort when levels are below the limit of detection.
Cite This Study
Aldous et al. (2011) conducted a cohort in suspected acute coronary syndromes (n=332). High-sensitivity troponin T (hsTnT) vs. Contemporary troponin I (TnI 3) and troponin T (TnT) assays was evaluated on MACE (composite of cardiovascular death, non-fatal myocardial infarction and revascularization) (AUC 0.70, 95% CI 0.63-0.76, p=0.001). High-sensitivity troponin T outperformed contemporary troponin T for predicting 2-year MACE in patients with suspected acute coronary syndromes (AUC 0.70 vs 0.61; P=0.001).