Diagnostic and prognostic performance of a novel high-sensitivity cardiac troponin T assay compared to a contemporary sensitive cardiac troponin I assay in patients with acute coronary syndrome
Clinical Research in Cardiology, 06/04/2012
Mueller M et al. – Using the 99th percentile cutoff for hs–cTnT and cTnI, both assays enable prediction of adverse long–term outcomes and earlier diagnosis of non–STEMI. Used as a continuous variable, the hs–cTnT assay showed superior performance compared to the cTnI assay, especially in regard to prognosis.Methods
- Authors measured hs–cTnT (Roche TnThs) and cTnI (Siemens Centaur Ultra) on presentation in 1,384 patients with suspected acute coronary syndrome (ACS) who underwent early invasive strategy within 24 h after presentation.
- Kaplan–Meier, Cox proportional hazards, and receiver–operating characteristic (ROC) analysis was used to compare their prognostic performance for the prediction of all–cause death and death/MI (myocardial infarction) after a median of 271 days.
- Authors also compared the diagnostic performance of these assays on presentation for early diagnosis of non–STEMI.
- Both hs–cTnT and cTnI were independently predictive of long–term death (OR 3.51 vs. 2.19) and the composite of death/MI (OR 9.24 vs. 3.61), across the spectrum of ACS and in patients without ACS.
- When used as a continuous variable, ROC analysis demonstrated significantly higher areas under the curve (AUC) for hs–cTnT as compared to cTnI for the prediction of death/MI (0.721 vs. 0.672, P = 0.024), a trend to better prediction of all–cause death (0.721 vs. 0.672, P = 0.093) and significantly higher AUC for early diagnosis of non–STEMI (0.965 vs. 0.901, P < 0.001).