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Direct comparison of high-sensitivity cardiac troponin i versus t for the early diagnosis of acute myocardial infarction

Session Rapid Fire - Acute coronary syndromes in the firing line

Speaker Maria Rubini Gimenez

Event : ESC Congress 2013

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Non-ST-Elevation Myocardial Infarction (NSTEMI)
  • Session type : Rapid Fire Abstracts

Authors : M Rubini Gimenez (Basel,CH), R Twerenbold (Basel,CH), T Reichlin (Basel,CH), B Moehring (Basel,CH), K Wildi (Basel,CH), B Meller (Basel,CH), P Haaf (Basel,CH), C Zellweger (Basel,CH), S Osswald (Basel,CH), C Mueller (Basel,CH)

Authors:
M. Rubini Gimenez1 , R. Twerenbold1 , T. Reichlin1 , B. Moehring1 , K. Wildi1 , B. Meller1 , P. Haaf1 , C. Zellweger1 , S. Osswald1 , C. Mueller1 , 1University Hospital Basel, Department of Cardiology - Basel - Switzerland ,

Citation:
European Heart Journal ( 2013 ) 34 ( Abstract Supplement ), 3

Purpose: The aim of our study was to compare the accuracy of high-sensitivity cardiac troponins (hs-cTn) I and T in the early diagnosis of acute myocardial infarction, as well as their utility to predict all-cause mortality.

Methods: In a prospective multicenter study we measured 2 different hs-cTn assays (hs-cTnI Abbott) and hs-cTnT Roche) and compared their diagnostic and prognostic accuracies in consecutive patients presenting to the emergency department (ED) with acute chest pain. The final diagnosis of AMI was adjudicated by two independent cardiologists using all information pertaining to the individual patient including serial measurements of hs-cTnT. Mean follow up (FU) was 24 months.

Results: Among 2211 consecutive patients, 21% had an adjudicated final diagnosis of AMI. The diagnostic accuracy as quantified by the area under the receiver-operating-characteristics curve (AUC) was slightly higher with the hs-cTnI assay (AUC 0.93; 95% confidence interval (CI) 0.92-0.94) than with the hs-cTnT (AUC 0.92; 95% CI 0.91-0.93; p = 0.078). In early presenters (<3h since chest pain onset) this difference (AUC for hs-cTnI 0.93; 95% CI 0.90-0.95; AUC for hs-cTnT 0.87; 95% CI 0.83-0.89) was much larger and highly statistically significant (p<0.001). The prognostic accuracy for all-cause mortality during FU, quantified by AUC, was significantly higher for hs-cTnT (AUC 0.79; 95% CI 0.78-0.81) as compared to hs-cTnI (AUC 0.76; 95% CI 0.74-0.77) p<0.001.

Conclusion: Both hs-cTnI and hs-cTnT provide high diagnostic and prognostic accuracy. The direct comparison revealed diagnostic superiority of hs-cTnI and prognostic superiority of hs-cTnT

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