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Comparing the prognostic value of ultra-sensitive cardiac troponin I versus high-sensitivity cardiac troponin T and I among patients with suspected myocardial infarction

Session Poster Session 7

Speaker Raphael Twerenbold

Event : ESC Congress 2018

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : R Twerenbold (Basel,CH), M Rubini Gimenez (Basel,CH), J Boeddinghaus (Basel,CH), T Nestelberger (Basel,CH), C Puelacher (Basel,CH), P Badertscher (Basel,CH), J Du Fay De Lavallaz (Basel,CH), D Wussler (Basel,CH), N Kozhuharov (Basel,CH), O Miro (Barcelona,ES), FJ Martin-Sanchez (Madrid,ES), B Morawiec (Katowice,PL), D Keller (Zurich,CH), T Reichlin (Basel,CH), C Mueller (Basel,CH)

Authors:
R. Twerenbold1 , M. Rubini Gimenez1 , J. Boeddinghaus1 , T. Nestelberger1 , C. Puelacher1 , P. Badertscher1 , J. Du Fay De Lavallaz1 , D. Wussler1 , N. Kozhuharov1 , O. Miro2 , F.J. Martin-Sanchez3 , B. Morawiec4 , D. Keller5 , T. Reichlin1 , C. Mueller1 , 1University Hospital Basel - Basel - Switzerland , 2Hospital Clinic de Barcelona - Barcelona - Spain , 3Hospital Clinic San Carlos - Madrid - Spain , 4Medical University of Silesia, Cardiology Department - Katowice - Poland , 5University Hospital Zurich - Zurich - Switzerland ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 1366

Background: Cardiac Troponin (cTn) is a powerful prognostic predictor of death and reinfarction in patients with suspected myocardial infarction (MI). It is unknown, whether the prognostic performance of a novel ultra-sensitive cardiac troponin I assay (us-cTnI-Clarity) with about 10-times higher analytical sensitivity is superior to the two best-in-class high-sensitivity cardiac troponin (hs-cTn) assays.

Purpose: We aimed to assess and directly compare the prognostic performance of us-cTnI and hs-cTnT/I.

Methods: In a prospective international multicentre diagnostic study enrolling patients presenting with suspected MI to the emergency department (ED), us-cTnI-Clarity, hs-cTnI-Architect and hs-cTnT-Elecsys was determined at baseline. Patients presenting with STEMI were excluded. Co-primary prognostic endpoints were all-cause mortality and future MI (excluding the index events) within two years. Time-dependent ROC curves were constructed to directly compare the predictive performance of the three investigated cTn-assays within two years.

Results: Among 1974 patients presenting with suspected MI to the ED, median follow-up time was 778 days (IQR, 734–913). Mortality at 30 days and two years was 0.8% (16/1974) and 6.5% (129/1974), respectively. Prevalence of MI at index admission was 17.4% (343/1974). Incidence of MI following the index admission was 1.3% (25/1974) and 4.9% (96/1974), respectively.

For the prediction of overall mortality within two years, the prognostic performance of us-cTnI-Clarity concentrations obtained at ED presentation was superior to hs-cTnI-Architect (p<0.001) but statistically inferior compared to hs-cTnT-Elecsys (p<0.001) at all time-points within 2 years, as evaluated by time-dependent ROC curve analysis (Figure 1A). E.g. the prognostic performance to predict mortality at two years, quantified by the area under the ROC curve, was 0.75 (95% CI, 0.73–0.77) for us-cTnI-Clarity, 0.74 (95% CI, 0.72–0.76) for hs-cTnI-Architect and 0.80 (95% CI, 0.78–0.82) for hs-TnT-Elecsys.

For the prediction of future MI within two years, the prognostic performance of us-cTnI-Clarity was comparable to hs-cTnI-Architect (p=0.155) but inferior to hs-cTnT-Elecsys (p<0.001; Figure 1B).

Conclusion: Hs-cTnT is superior to us-cTnI and hs-cTnI in the prediction of all-cause mortality and future MI among patients with suspected MI.

Figure 1

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