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September 20, 2013Clinical ChemistryOpen Access

Prognostic Performance of a High-Sensitivity Cardiac Troponin I Assay in Patients with Non–ST-Elevation Acute Coronary Syndrome

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Why the study?

Does a high-sensitivity cardiac troponin I assay improve prognostic prediction of cardiovascular death or new MI compared to a fourth-generation cTnT assay in patients with NSTE-ACS?

Population

4695 patients with non-ST-segment elevation acute coronary syndromes from the EARLY-ACS and SEPIA-ACS1-TIMI…

Comparison

High-sensitivity cardiac troponin I assay vs Commercial fourth generation cTnT assay

Design

Cohort

Follow-up

30 days

Authors

EBErin A. BohulaMBMarc P. BonacaPJPetr Jarolı́m

Discussion

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Overview

hs-cTnI elevation may refine short-term risk assessment in NSTE-ACS; extends troponin utility but should not yet alter management without prospective validation.

Key Points

  • Evaluate the prognostic performance of a high-sensitivity cardiac troponin I (hs-cTnI) assay compared to fourth-generation cardiac troponin T for 30-day outcomes in non–ST-elevation acute coronary syndrome.
  • Analyzed baseline hs-cTnI and fourth-generation cTnT concentrations in 4,695 patients with NSTE-ACS from the EARLY-ACS and SEPIA-ACS1-TIMI 42 clinical trials.
  • Evaluated the primary endpoint of cardiovascular death or new myocardial infarction at 30 days using the 99th percentile cutoffs (26 ng/L for hs-cTnI; 10 ng/L for cTnT) and sex-specific percentiles.
  • Patients with hs-cTnI ≥99th percentile had a significantly higher rate of 30-day cardiovascular death or MI than those with hs-cTnI <99th percentile (9.7% vs 3.0%; adjusted OR 3.7; 95% CI, 2.3–5.7; P < 0.001).
  • Among patients classified as negative by standard cTnT (<10 ng/L), baseline hs-cTnI ≥26 ng/L identified a significantly increased 30-day risk of cardiovascular death or MI (9.2% vs 2.9%, P = 0.002).

Structured PICO

Does a high-sensitivity cardiac troponin I assay improve prognostic prediction of cardiovascular death or new MI compared to a fourth-generation cTnT assay in patients with NSTE-ACS?

P
Population
4695 patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) from the EARLY-ACS and SEPIA-ACS1-TIMI 42 trials
I
Intervention
High-sensitivity cardiac troponin I (hs-cTnI) assay (Abbott ARCHITECT)
C
Comparator
Commercial fourth generation cTnT assay
O
Outcome
Composite of cardiovascular death or new myocardial infarction (MI) at 30 dayscomposite

The high-sensitivity cardiac troponin I assay identifies a clinically relevant higher risk of recurrent cardiovascular events in NSTE-ACS patients, even among those with negative results on standard fourth-generation assays.

Cite This Study

Bohula et al. (2013) studied this question.

synapsesocial.com/papers/6a762fd71c684509e2008aa5https://doi.org/10.1373/clinchem.2013.206441
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Prognostic implications of high-sensitivity cardiac troponin T assay in a real-world population with non-ST-elevation acute coronary syndrome2018 · 15 citations
  2. 2Prognostic performance of a high-sensitivity assay for cardiac troponin I after non-ST elevation acute coronary syndrome: Analysis from MERLIN-TIMI 362014 · 21 citations
  3. 3Incremental Value of High-Sensitivity Cardiac Troponin T for Risk Prediction in Patients with Suspected Acute Myocardial Infarction2011 · 54 citations
  4. 4Prognostic Implications of Low Level Cardiac Troponin Elevation Using High‐Sensitivity Cardiac Troponin T2015 · 19 citations
  5. 5Point: Detection of Myocardial Infarction—Is It All Troponin?2011 · 4 citations