High-Sensitivity Cardiac Troponin Risk Cutoffs for Acute Cardiac Outcomes at Emergency Department Presentation

Peter A Kavsak; Andrew Worster; Jinhui Ma; Colleen Shortt; Natasha Clayton; Jonathan Sherbino; Stephen A Hill; Matthew McQueen; Shamir R Mehta; Philip J Devereaux

doi:10.1016/j.cjca.2017.04.011

High-Sensitivity Cardiac Troponin Risk Cutoffs for Acute Cardiac Outcomes at Emergency Department Presentation

Can J Cardiol. 2017 Jul;33(7):898-903. doi: 10.1016/j.cjca.2017.04.011. Epub 2017 May 3.

Authors

Affiliations

¹ Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada. Electronic address: [email protected].
² Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada.
³ School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, and the Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
⁴ Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
⁵ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁶ Division of Cardiology, and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.

PMID: 28668141
DOI: 10.1016/j.cjca.2017.04.011

Abstract

The optimal high-sensitivity cardiac troponin (hs-cTn) cutoffs for determining risk in patients who present with acute coronary syndrome symptoms are unknown. In 1137 emergency department patients we calculated adjusted relative risks for a composite outcome (myocardial infarction, unstable angina, heart failure, ventricular arrhythmia, or cardiovascular death) within 7 days for the presentation of hs-cTnT (Roche) and hs-cTnI (Abbott) assay concentrations on the basis of literature cutoffs. Patients with hs-cTn concentrations ≥ 14 ng/L had an adjusted relative risk of 4.9 for the composite outcome, with different hs-cTnT/hs-cTnI concentration ranges yielding higher risks. A common low-risk cutoff of 14 ng/L may be used for hs-cTn with higher cutoffs identifying high-risk patients.

Trial registration: ClinicalTrials.gov NCT01994577.

Publication types

Clinical Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Biomarkers / blood
Cause of Death / trends
Emergency Service, Hospital*
Follow-Up Studies
Heart Diseases / blood
Heart Diseases / diagnosis*
Heart Diseases / epidemiology
Humans
Incidence
Ontario / epidemiology
Prevalence
Prospective Studies
ROC Curve
Reproducibility of Results
Risk Factors
Survival Rate / trends
Troponin I / blood*

Substances

Biomarkers
Troponin I

Associated data

ClinicalTrials.gov/NCT01994577

Grants and funding

CIHR/Canada