Cihan BEDEL, Mustafa KORKUT, Aslıhan YÜRÜKTÜMEN ÜNAL, Osman GÜRSOY ÜNAL, Manolya YILDIZ ÜNAL

The value of ultra-sensitive troponin I in determining theprognosis of patients with the suspected acute coronarysyndrome in the emergency department

Aim: Acute coronary syndromes (ACS) have significant mortality and morbidity in our country and the world. With the developmentof technology, early diagnosis and treatment may be possible. Ultra-sensitive troponin I (us-TnI) test developed a few years ago hasprovided accurate detection of even lower troponin concentrations using a microparticle immunoassay. There are very few studies inthe literature about us-TnI showing prognosis. In this study, we aimed to find the value of the newly introduced us-TnI in determiningmortality in one-month and three-month follow-ups.Materials and Methods: The study included all patients who were admitted to our tertiary emergency department (ED) betweenNovember 2015 and June 2016 and whose us-TnI levels was studied considering ACS. Whether the follow-up of the patients includedin the study resulted in death was determined. The patients were classified according to the date of death based on their mortalitystatus at the end of the first month and third month.Results: It was found that of the patients, 4.0% (n=264) died within 1 month after the first troponin measurement, while 6.8% (n=444)died within 3 months after the first troponin measurement. The AUC of the baseline us-TnI value in determining cardiac death at theend of the first month was 0.803 (95% Cl: 0.793-0.813) and the AUC of the baseline us-TnI value in determining cardiac death at theend of the third month was 0.763 (95% Cl: 0.752-0.773).Conclusion: Us-TnI studied at the time of admission to ED is an early indicator of mortality in patients with the diagnosis of ACS.

PDF

___

1. Gok G, Zoghi M, Sinan UY, et al. Demographics of patients with heart failure who were over 80 years old and were admitted to the cardiology clinics in Turkey. Anatol J Cardiol 2019;21:196-205.
2. Windecker S, Neumann FJ, Jüni P, et al. Considerations for the choice between coronary artery bypass grafting and percutaneous coronary intervention as revascularization strategies in major categories of patients with stable multivessel coronary artery disease: an accompanying article of the task force of the 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart 2019;40:204-12.
3. Bekler A, Altun B, Gazi E, et al. Comparison of the GRACE risk score and the TIMI risk index in predicting the extent and severity of coronary artery disease in patients with acute coronary syndrome. Anatol J Cardiol 2015;15:801.
4. Body R, Mueller C, Giannitsis E, et al. The use of very low concentrations of high-sensitivity troponin T to rule out acute myocardial infarction using a single blood test. Acad Emerg Med 2016;23:1004-13.
5. Crea F, Libby P. Acute coronary syndromes: the way forward from mechanisms to precision treatment. Circulation 2017;136:1155-66.
6. Noll S, Alvey H, Jayaprakash N, et al. The utility of the triage electrocardiogram for the detection of STsegment elevation myocardial infarction. Am J Emerg Med 2018;36:1771-74.
7. Hamm CW, Giannitsis E, Katus HA. Cardiac troponin elevations in patients without acute coronary syndrome. Circulation 2002;106:2871-2.
8. Weber M, Bazzino O, Estrada JLN, et al. Improved diagnostic and prognostic performance of a new high-sensitive troponin T assay in patients with acute coronary syndrome. Am Heart J 2011;162:81-8.
9. Meigher S, Thode HC, Peacock WF, et al. Causes of elevated cardiac troponins in the emergency department and their associated mortality. Acad Emerg Med 2016;23:1267-73.
10. Apple FS, Sandoval Y, Jaffe AS, et al. Cardiac troponin assays: guide to understanding analytical characteristics and their impact on clinical care. Clin Chem 2017;63:73-81.
11. Mair J, Lindahl B, Hammarsten O, et al. How is cardiac troponin released from injured myocardium? Eur Heart J Acute Cardiovasc Care 2018;7:553-60.
12. Todd J, Freese B, Lu A, et al. Ultrasensitive flow-based immunoassays using single-molecule counting. Clin Chem 2007;53:1990-5.
13. Neumann JT, Havulinna AS, Zeller T, et al. Comparison of three troponins as predictors of future cardiovascular events–prospective results from the FINRISK and BiomaCaRE studies. PloS one 2014;9:e90063.
14. Aycicek GS, Unsal P, Esme M, et al. Could cardiac troponin I levels predict mortality in the elderly? Aging Clin Exp Res 2019;31:435.
15. Twerenbold R, Gimenez MR, Boeddinghaus J, et al. Comparing the prognostic value of ultra-sensitive cardiac troponin I versus high-sensitivity cardiac troponin T and I among patients with suspected myocardial infarction. Eur Heart J Cardiovasc Pharmacother 2018;39:566.
16. Tveit SH, Myhre PL, Røsjø H, et al. Relative Prognostic Merit of High-sensitivity Cardiac Troponin T and Ultra-Sensitivity Cardiac Troponin I in Patients with Suspected Acute Coronary Syndrome. Circulation 2018;138:16196.
17. Ince FD, Dogan N, Kahya Eren N, et al. The Diagnostic Value of Ultra-Troponin I in Patients Admitted to Emergency Department with Chest Pain and Performed Coronary Angiography. Tepecik Eğit. ve Araşt. Hast. Dergisi 2015; 25:33-7.
18. Apple FS, Smith SW, Pearce LA, et al. Use of the Centaur TnI-Ultra assay for detection of myocardial infarction and adverse events in patients presenting with symptoms suggestive of acute coronary syndrome. Clin Chem 2008;54:723-8.
19. Reichlin T, Irfan A, Twerenbold R, et al. Utility of absolute and relative changes in cardiac troponin concentrations in the early diagnosis of acute myocardial infarction. Circulation 2011;124:136-45.
20. Scharnhorst V, Krasznai K, van’t Veer M, et al. Rapid detection of myocardial infarction with a sensitive troponin test. Am J Clin Pathol 2011;135:424-8.
21. Body R, Burrows G, Carley S, et al. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a sensitive troponin I assay. Ann Clin Biochem 2015;52:543-9.
22. 22. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37:267-315.
23. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;64:139-228.
24. Rubini Gimenez M, Twerenbold R, Reichlin T, et al. Direct comparison of high-sensitivity-cardiac troponin I vs. T for the early diagnosis of acute myocardial infarction. Eur Heart J 2014;35:2303-11.
25. Haaf P, Reichlin T, Twerenbold R, et al. Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays. Eur Heart J 2014;35:365-75.