1. Diagnostic and prognostic implications using age- and gender-specific cut-offs for high-sensitivity cardiac troponin T — Sub-analysis from the TRAPID-AMI study
- Author
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Moritz Biener, Hugo A. Katus, Tomas Jernberg, Robert H. Christenson, Mehrshad Vafaie, Mauro Panteghini, Mario Plebani, Christian Mueller, Franck Verschuren, Richard Body, Christopher DeFilippi, Evangelos Giannitsis, Matthias Mueller-Hennessen, Peter Dilba, James McCord, Michael Christ, John K. French, Miguel Santalo-Bel, and Bertil Lindahl
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,Internationality ,Myocardial Infarction ,030204 cardiovascular system & hematology ,AMI ,Cohort Studies ,03 medical and health sciences ,Age ,Sex Factors ,0302 clinical medicine ,Diagnosis ,Gender ,High-sensitivity cardiac Troponin T, 99th percentile ,Prognosis ,Age Factors ,Aged ,Biomarkers ,Female ,Follow-Up Studies ,Humans ,Middle Aged ,Prospective Studies ,Retrospective Studies ,Troponin T ,Medicine (all) ,Cardiology and Cardiovascular Medicine ,Internal medicine ,Medicine ,030212 general & internal medicine ,Myocardial infarction ,High-sensitivity cardiac Troponin T ,Prospective cohort study ,business.industry ,Retrospective cohort study ,Emergency department ,medicine.disease ,Surgery ,Cohort ,99th percentile ,business ,Cohort study - Abstract
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 14 ng/L to previously proposed age-and gender-dependent hs-cTnT 99th percentile cut-offs (28 ng/L for >= 65 years, 9 ng/L for female and 15.5 ng/L for male patients). Patients were further clinically adjudicated into acute coronary syndrome (ACS) and non-ACS. Results: For patients >= 65 years, 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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
- Published
- 2016