TY - JOUR

T1 - Predictive and prognostic value of different cardiac troponin assays

T2 - a nationwide register-based cohort study

AU - Hasselbalch, Rasmus Bo

AU - Schultz, Martin

AU - Schytz, Philip Andreas

AU - Kristensen, Jonas Henrik

AU - Strandkjaer, Nina

AU - Pries-Heje, Mia

AU - Carlson, Nicholas

AU - Schou, Morten

AU - Bundgaard, Henning

AU - Torp-Pedersen, Christian

AU - Iversen, Kasper Karmark

PY - 2023

Y1 - 2023

N2 - Aims Guidelines do not differentiate between the available assays of cardiac troponin (cTn). We compared the prognostic and predictive ability of cTn assays. Methods and results This was a nationwide cohort study of patients with acute coronary syndrome (ACS) and >= 2 cTn measurements of one of four assays: Roche high-sensitivity cTnT (hs-cTnT), Abbott high sensitivity cTnI (hs-cTnI), Siemens Vista cTnI, and Siemens cTnI Ultra. Data were collected from Danish registries from 2009-18. Peak cTn concentration normalized to the 99(th) percentile was used. Outcomes were myocardial infarction (MI) during admission, one-year all-cause-, cardiovascular-, and non-cardiovascular mortality. Receiver operating characteristics and logistic regression calculating odds ratios (OR) were used. A total of 90 705 patients were included, of which 20 550 (23%) had MI. Siemens Vista cTnI was the strongest predictor of MI, Area under the curve (auc) 0.93 (95% CI 0.93-0.93). In 1 year 9012 (9.9%) of patients had died. An inverted U-shape relationship was observed between concentration of cTn and all-cause mortality. Hs-cTnT OR 21.3 (95% CI 18.4-24.8) at 2-5 times the 99(th) percentile and 12.1 (95% CI 10.3-14.1) for concentrations >100 times the 99(th) percentile. The inverted U-shape relationship was only present for non-cardiovascular mortality. The strongest predictor of cardiovascular mortality was hs-cTnT, OR 11.3 (95% CI 6.4-21.8) at 1-2 times the 99(th) percentile and 88.8 (95% CI 53.2-163.0) for concentrations >100 times the 99(th) percentile. Conclusion Siemens Vista cTnI was the strongest predictor of MI and hs-cTnT was the strongest predictor of mortality. An inverted U-shape relationship was observed between cTn concentration and non-cardiovascular mortality.

AB - Aims Guidelines do not differentiate between the available assays of cardiac troponin (cTn). We compared the prognostic and predictive ability of cTn assays. Methods and results This was a nationwide cohort study of patients with acute coronary syndrome (ACS) and >= 2 cTn measurements of one of four assays: Roche high-sensitivity cTnT (hs-cTnT), Abbott high sensitivity cTnI (hs-cTnI), Siemens Vista cTnI, and Siemens cTnI Ultra. Data were collected from Danish registries from 2009-18. Peak cTn concentration normalized to the 99(th) percentile was used. Outcomes were myocardial infarction (MI) during admission, one-year all-cause-, cardiovascular-, and non-cardiovascular mortality. Receiver operating characteristics and logistic regression calculating odds ratios (OR) were used. A total of 90 705 patients were included, of which 20 550 (23%) had MI. Siemens Vista cTnI was the strongest predictor of MI, Area under the curve (auc) 0.93 (95% CI 0.93-0.93). In 1 year 9012 (9.9%) of patients had died. An inverted U-shape relationship was observed between concentration of cTn and all-cause mortality. Hs-cTnT OR 21.3 (95% CI 18.4-24.8) at 2-5 times the 99(th) percentile and 12.1 (95% CI 10.3-14.1) for concentrations >100 times the 99(th) percentile. The inverted U-shape relationship was only present for non-cardiovascular mortality. The strongest predictor of cardiovascular mortality was hs-cTnT, OR 11.3 (95% CI 6.4-21.8) at 1-2 times the 99(th) percentile and 88.8 (95% CI 53.2-163.0) for concentrations >100 times the 99(th) percentile. Conclusion Siemens Vista cTnI was the strongest predictor of MI and hs-cTnT was the strongest predictor of mortality. An inverted U-shape relationship was observed between cTn concentration and non-cardiovascular mortality.

KW - Cardiac troponin

KW - biomarkers

KW - myocardial infarction

KW - HIGH-SENSITIVITY TROPONIN

KW - ACUTE CORONARY SYNDROME

KW - 99TH PERCENTILE

KW - SYSTEM

U2 - 10.1093/ehjqcco/qcac065

DO - 10.1093/ehjqcco/qcac065

M3 - Journal article

C2 - 36264293

VL - 9

SP - 592

EP - 599

JO - European Heart Journal - Quality of Care and Clinical Outcomes

JF - European Heart Journal - Quality of Care and Clinical Outcomes

SN - 2058-5225

IS - 6

ER -