High-Sensitivity Cardiac Troponin T: Risk Stratification Tool in Patients with Symptoms of Chest Discomfort
نویسندگان
چکیده
BACKGROUND Recent studies have demonstrated the association between increased concentrations of high-sensitivity cardiac troponin T (hs-cTnT) and the incidence of myocardial infarction, heart failure, and mortality. However, most prognostic studies to date focus on the value of hs-cTnT in the elderly or general population. The value of hs-cTnT in symptomatic patients visiting the outpatient department remains unclear. The aim of this study was to investigate the prognostic value of hs-cTnT as a biomarker in patients with symptoms of chest discomfort suspected for coronary artery disease and to assess its additional value in combination with other risk stratification tools in predicting cardiac events. METHODS We studied 1,088 patients (follow-up 2.2 ± 0.8 years) with chest discomfort who underwent coronary calcium scoring and coronary CT-angiography. Traditional cardiovascular risk factors and concentrations of hs-cTnT, N-terminal pro-brain-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP) were assessed. Study endpoint was the occurrence of late coronary revascularization (>90 days), acute coronary syndrome, and cardiac mortality. RESULTS Hs-cTnT was a significant predictor for the composite endpoint (highest quartile [Q4]>6.7 ng/L, HR 3.55; 95%CI 1.88-6.70; P<0.001). Survival analysis showed that hs-cTnT had significant predictive value on top of current risk stratification tools (Chi-square change P<0.01). In patients with hs-cTnT in Q4 versus <Q4, a 2- to 3-fold increase in cardiovascular risk was noticed, either when corrected for high or low Framingham risk score, coronary calcium scoring, or CT-angiography assessment (HR 3.11; 2.73; 2.47; respectively; all P<0.01). This was not the case for hsCRP and NT-proBNP. CONCLUSIONS Hs-cTnT is a useful prognostic biomarker in patients with chest discomfort suspected for coronary artery disease. In addition, hs-cTnT was an independent predictor for cardiac events when corrected for cardiovascular risk profiling, calcium score and CT-angiography results.
منابع مشابه
Chest pain and high troponin level without significant respiratory symptoms in young patients with COVID-19
Background: Of all patients infected with COVID-19, 95% have mild symptoms, but 5% may experience severe illness. There are reports of myocardial injury associated with the COVID19 infection in middle aged and old people with baseline cardiac conditions. Acute myocardial injury has been suggested as a marker for disease severity. Sometimes it is hard to differentiate between acute coronary synd...
متن کاملCardiac enzyme in emergency medicine
Objective: Acute chest pain is an important and frequently occurring symptom in patients. Chest pain is often a sign of ischemic heart disease. Chest pain due to suspected Acute Coronary Syndrome (ACS) is responsible for a large and ijncreasing number of hospital attendances and admissions. Current practice for suspected ACS involves troponin testing 10–12 hours after symptom o...
متن کاملChest pain and high-sensitivity troponin: What is the evidence?
The number of attendances and admissions of patients with chest pain to hospitals in England and Wales is increasing. Initial assessment may be unrewarding. Consequently, cardiac troponin has become the mainstay of investigation for non-ST-segment-elevation myocardial infarction and unstable angina, although only a small proportion of patients are eventually diagnosed as such. Current National ...
متن کاملAddition of heart score to high-sensitivity troponin T versus conventional troponin T in risk stratification of patients with chest pain at the coronary emergency rooms
Patients with chest pain have a large impact on available resources in coronary emergency rooms (CER). Clinical judgement, ECG, risk scores and biomarkers guide in risk stratification. We investigated if high-sensitivity troponin T (HsT) and the HEART Score could contribute to risk stratification at the CER. All patients with chest pain, without elevated conventional troponin levels at presenta...
متن کاملEvolution of Biochemical Diagnosis of Acute Coronary Syndrome – Impact Factor of High Sensitivity Cardiac Troponin Assays
In patients with acute thoracic pain and non-conclusive acute myocardial infarction electrocardiogram (non-STEMI), the biochemical diagnosis is an essential tool for its correct treatment. The study of the chosen biomarker for cardiac injury has raised interest during decades. The appearance of immunoassays to assess cardiac troponin I or T has reached great improvements in the diagnosis, evolu...
متن کامل