Diagnostic and prognostic implications using age- and gender-specific cut-offs for high-sensitivity cardiac troponin T: sub-analysis from the TRAPID-AMI study
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 e...
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| Main Authors: | , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
3 February 2016
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| In: |
International journal of cardiology
Year: 2016, Volume: 209, Pages: 26-33 |
| ISSN: | 1874-1754 |
| DOI: | 10.1016/j.ijcard.2016.01.213 |
| Online Access: | Verlag, Volltext: https://doi.org/10.1016/j.ijcard.2016.01.213 Verlag, Volltext: http://www.sciencedirect.com/science/article/pii/S0167527316301899 
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| Author Notes: | Matthias Mueller-Hennessen, Bertil Lindahl, Evangelos Giannitsis, Moritz Biener, Mehrshad Vafaie, Christopher R. deFilippi, Michael Christ, Miguel Santalo-Bel, Mauro Panteghini, Mario Plebani, Franck Verschuren, Tomas Jernberg, John K. French, Robert H. Christenson, Richard Body, James McCord, Peter Dilba, Hugo A. Katus, Christian Mueller, for the TRAPID-AMI Investigators |
| Summary: | 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. |
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| Item Description: | Gesehen am 08.11.2019 |
| Physical Description: | Online Resource |
| ISSN: | 1874-1754 |
| DOI: | 10.1016/j.ijcard.2016.01.213 |