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Current European guidelines for the diagnosis of myocardial infarction recommend to consider a rise and/or fall of cardiac biomarkers. Whether rising or falling patterns of high-sensitivity cardiac troponin T (hs-cTnT) perform better in discriminating non-STEMI from non-ACS has not been evaluated yet.
We compared protocols of rising and falling absolute and relative hs-cTnT changes in an unselected ED population.
635 patients presenting with suspected unstable angina, non-STEMI, or acute symptoms and increased hs-cTnT >99th percentile value were enrolled. 572 patients met the inclusion criteria presenting with consistently rising patterns (n=254, 44.4%), consistently falling patterns (n=224, 39.2%) or falling patterns following an initial rise (n=94, 16.4%). Final diagnoses included 66 (11.5%) patients with UAP, 141 (24.7%) patients with non-STEMI, and 365 (63.8%) patients with hs-cTnT elevations not due to ACS. Supporting a relationship between time delay to presentation and kinetic pattern, rising values were found more frequently in patients with non-STEMI, as compared to non-ACS (OR 3.69, CI 2.46-5.53, p<0.0001), and falling patterns were observed more frequently in patients with non-ACS conditions (OR 3.56, CI 2.24-5.63, p<0.001). Addition of positive but not negative changes increased diagnostic performance of hs-cTnT concentrations at presentation (Positive: AUC: 0.680 [95%CI: 0.618-0.742] vs. 0.861 [95%CI: 0.822-0.900, p<0.0001], negative: AUC: 0.678 [95%CI: 0.545-0.812] vs. 0.741 [95%CI: 0.635-0.847], p=ns).
Detection of rising hs-cTnT levels ameliorates discrimination of non-STEMI from non-ACS in an unselected emergency department population.
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: 1303-213
- 2013 American College of Cardiology Foundation