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Sensitive troponin assay predicts outcome in syncope.
Matthew J Reed1, Nicholas L Mills, Christopher J Weir
1Emergency Medicine Research Group Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK. mattreed1@hotmail.com
Emergency Medicine Journal : EMJ
|September 11, 2012
Summary
Elevated plasma troponin levels in emergency department patients with syncope predict a higher risk of serious outcomes and death within one year. Higher troponin concentrations correlate with increased risk, suggesting a role in syncope patient risk stratification.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Diagnostics
Background:
- Syncope is a common presentation in emergency departments, often associated with significant morbidity and mortality.
- Risk stratification of syncope patients is crucial for appropriate management and resource allocation.
- Sensitive troponin assays may offer new insights into predicting outcomes in syncope.
Purpose of the Study:
- To evaluate the predictive value of sensitive plasma troponin concentrations for serious outcomes and all-cause death at 1-month and 1-year in emergency department patients presenting with syncope.
- To determine if troponin levels can aid in the risk stratification of syncope patients.
Main Methods:
- Prospective cohort study involving adult patients admitted from the emergency department with syncope.
- Plasma troponin I levels were measured using a sensitive assay (ARCHITECT STAT sensitive troponin I) 12 hours post-syncope.
- Primary endpoints included a composite of serious outcome or all-cause death at 1 month and 1 year.
Main Results:
- A significant proportion (77%) of syncope patients had detectable troponin levels.
- Higher troponin concentrations (≥0.03 ng/ml and ≥0.05 ng/ml) were observed in a substantial number of patients.
- A clear dose-response relationship was found: the risk of serious composite outcomes increased progressively with higher troponin concentration quintiles at both 1 month and 1 year.
Conclusions:
- The majority of emergency department patients admitted with syncope exhibit detectable plasma troponin concentrations.
- Peak troponin concentration is significantly associated with an increased risk of serious outcomes and death.
- Plasma troponin measurement holds potential as a valuable tool for the risk stratification of patients experiencing syncope.