Author + information
- Maria Teresa Cardillo,
- Luigi Biasucci,
- Chiara De Waure,
- Maria Giulia Marini,
- Annalisa Caroli,
- Gianluigi Quaranta,
- massimo gustapane,
- Gina Biasillo,
- Martina Zaninotto,
- Mario Plebani and
- Filippo Crea
High sensitivity troponin T (hsTnT) has higher sensitivity than previous generation troponin (cTnT) for diagnosis of acute coronary syndrome (ACS) in emergency department (ED) but lower specifity. Our aim was to assess whether an association exists between hsTnT and number of vessels with significant plaques. These results were compared with those of cTnT.
Materials and Methods
Among 452 subjects admitted to ED with chest pain, we selected 59 pts who underwent coronary angiography, 44 were discharged with a diagnosis of ACS. 39 pts had hsTnT>14 ng/L, 29 cTnT>0.03 ng/ml. Pts were classified as having no significant disease (0) or 1,2,3 or 4 (in case of 2 vessels plus LMCA) disease vessels (DV). We assessed the association of the number of DV with quartiles of hsTnT and cTnT. A linear multivariable regression analysis was carried out in order to study if the following variables were associated to the number of DV: gender, age, ECG abnormalities, hypertension, diabetes, dyslipidemia, smoking, family history of CAD, CHF, AF, hsTnT and cTnT levels, EF, time from symptoms onset and diagnosis of ACS. A univariable analysis was performed with Spearman correlation to identify variables to be gathered in the model. Results are shown as unstandardized coefficient (B) with 95% Confidence Intervals (95%CI).
The mean number of occluded blood vessels was 1.4 (SD 1.1). Number of DV increased significantly through the quartiles of either hsTnT and cTnT(p<0.05). HsTnT was more accurate in identifying pts with CAD, as only 5 pts with negative hsTnT had CAD (4:1DV, 1:2DV) but 19 subjects with negative cTnT had significant CAD (12:1DV, 4:2DV, 2:3DV, 1:4DV), p<0.05. The multivariable analysis showed that the number of DV was dependent on: EF (B–0.200, 95%CI–0.041, 0.002; p=0.06), ACS discharge (B 1.196, 95%CI 0.600, 1.793; p<0.01) and cTnT positivity (B 0.531, 95%CI 0.005, 1.057; p=0.05), hsTnT didn't enter this equation.
HsTnT identified 14 more pts out of 59 (24%) with significant CAD than cTnT and seems to be more sensitive and less dependent on confounders in identyfing, among patients with chest pain, those with a significant CAD, leading to a better risk stratification and use of resource.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Cardiac Biomarkers and Cardiovascular Risk
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1303-211
- 2013 American College of Cardiology Foundation