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Implications of Introducing High-Sensitivity Cardiac Troponin T Into Clinical Practice Data From the SWEDEHEART Registry
Karolinska Institute, Sweden.
Uppsala University, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
Karolinska Institute, Sweden.
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2015 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 65, no 16, 1655-1664 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND Cardiac troponin is the preferred biomarker for diagnosing myocardial infarction (MI). OBJECTIVES The aim of this study was to examine the implications of introducing high-sensitivity cardiac troponin T (hs-cTnT) into clinical practice and to define at what hs-cTnT level risk starts to increase. METHODS We analyzed data from 48,594 patients admitted because of symptoms suggesting an acute coronary syndrome and who were entered into a large national registry. Patients were divided into Group 1, those with hs-cTnT less than6 ng/l; Group 2, those with hs-cTnT 6 to 13 ng/l; Group 3, those with hs-cTnT 14 to 49 ng/l (i.e., a group in which most patients would have had a negative cardiac troponin T with older assays); and Group 4, those with hs-cTnT greater than= 50 ng/l. RESULTS There were 5,790 (11.9%), 6,491 (13.4%), 10,476 (21.6%), and 25,837 (53.2%) patients in Groups 1, 2, 3, and 4, respectively. In Groups 1 to 4, the proportions with MI were 2.2%, 2.6%, 18.2%, and 81.2%. There was a stepwise increase in the proportion of patients with significant coronary stenoses, left ventricular systolic dysfunction, and death during follow-up. When dividing patients into 20 groups according to hs-cTnT level, the adjusted mortality started to increase at an hs-cTnT level of 14 ng/l. CONCLUSIONS Introducing hs-cTnT into clinical practice has led to the recognition of a large proportion of patients with minor cardiac troponin increases (14 to 49 ng/l), the majority of whom do not have MI. Although a heterogeneous group, these patients remain at high risk, and the adjusted mortality rate started to increase at the level of the 99th percentile in healthy controls.

Place, publisher, year, edition, pages
Elsevier , 2015. Vol. 65, no 16, 1655-1664 p.
Keyword [en]
acute coronary syndrome; assay; chest pain; myocardial infarction
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-118046DOI: 10.1016/j.jacc.2015.02.044ISI: 000353337300009PubMedID: 25908071OAI: oai:DiVA.org:liu-118046DiVA: diva2:812995
Note

Funding Agencies|Roche Diagnostics

Available from: 2015-05-21 Created: 2015-05-20 Last updated: 2016-04-24

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Alfredsson, Joakim
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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