Diagnostic and prognostic implications using age- and gender-specific cut-offs for high-sensitivity cardiac troponin T — Sub-analysis from the TRAPID-AMI study
Articolo
Data di Pubblicazione:
2016
Citazione:
Diagnostic and prognostic implications using age- and gender-specific cut-offs for high-sensitivity cardiac troponin T — Sub-analysis from the TRAPID-AMI study / M. Mueller Hennessen, B. Lindahl, E. Giannitsis, M. Biener, M. Vafaie, C.R. Defilippi, M. Christ, M. Santalo Bel, M. Panteghini, M. Plebani, F. Verschuren, T. Jernberg, J.K. French, R.H. Christenson, R. Body, J. Mccord, P. Dilba, H.A. Katus, C. Mueller. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - 209(2016 Apr 15), pp. 26-33. [10.1016/j.ijcard.2016.01.213]
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 b 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.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Age; Gender; AMI; High-sensitivity cardiac Troponin T; 99th percentile; Diagnosis; Prognosis
Elenco autori:
M. Mueller Hennessen, B. Lindahl, E. Giannitsis, M. Biener, M. Vafaie, C.R. Defilippi, M. Christ, M. Santalo Bel, M. Panteghini, M. Plebani, F. Verschuren, T. Jernberg, J.K. French, R.H. Christenson, R. Body, J. Mccord, P. Dilba, H.A. Katus, C. Mueller
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