High-sensitivity troponin T as a diagnostic tool for acute coronary syndrome in the real world: an observational
Catharina Borna1, Johan Thelin, Bertil Ohlin
1Section of Emergency Medicine, Department of Clinical Sciences at Lund, Faculty of Medicine, University of Lund, Lund, Sweden.
Insights
High-sensitivity troponin T (HsTnT) testing may not reliably rule out acute coronary syndrome (ACS) even after prolonged monitoring. Current protocols may overestimate HsTnT accuracy in emergency settings.
Area of Science:
- Cardiology
- Emergency Medicine
- Biomarker Analysis
Background:
- European Society of Cardiology guidelines suggest rapid troponin testing for acute coronary syndrome (ACS).
- High-sensitivity troponin T (HsTnT) is used to rule out ACS with a 3-hour protocol.
- Routine care evaluation of HsTnT diagnostic and prognostic performance is needed.
Purpose of the Study:
- To evaluate the diagnostic performance of HsTnT for ACS in chest pain patients.
- To assess the prognostic performance of HsTnT for adverse outcomes within 60 days.
- To determine if prolonged HsTnT testing improves ACS diagnosis in routine care.
Main Methods:
- Retrospective analysis of 773 patients with chest pain suspicious of ACS.
- HsTnT levels measured at admission, 3-4 hours, and 6-7 hours.
- Evaluation of diagnostic accuracy and 60-day composite endpoint (ACS, revascularization, death).
Main Results:
- Sensitivity for ACS was 68% (admission), 79% (3-4h), and 81% (6-7h).
- Sensitivity for acute myocardial infarction alone was high (97% at 3-4h) with a negative predictive value of 99%.
- In older adults (≥75 years), 63% had positive HsTnT on admission, but only 39% had ACS.
Conclusions:
- Prolonged HsTnT testing beyond 3-4 hours does not enhance ACS diagnostic performance.
- While sensitive for acute myocardial infarction, HsTnT sensitivity for ACS is insufficient for definitive exclusion.
- Positive HsTnT results are frequently false positives, questioning its utility in improving ACS diagnosis in emergency care.
Background:
The 2011 European Society of Cardiology guidelines state that acute coronary syndrome (ACS) may be excluded with a rapid 3 h high-sensitivity troponin T (HsTnT) sampling protocol. We aimed to evaluate the diagnostic and prognostic performance of HsTnT in patients with chest pain admitted with possible ACS in routine care.
Methods:
A total of 773 consecutive patients admitted for in-hospital care for chest pain suspicious of ACS were included retrospectively. HsTnT values at admission and at 3-4 and 6-7 h were analysed for diagnostic performance. In addition, prognostic performance towards a combined 60-day endpoint of ACS, nonelective revascularization or death of all causes was studied.
Results:
Twenty-three per cent of the patients had ACS during the hospital stay and 1.6% had an endpoint after discharge but within 60 days. The sensitivity of HsTnT for ACS at admission, 3-4 and 6-7 h was only 68, 79 and 81%, respectively. Sensitivity and negative predictive value for acute myocardial infarction alone were 80 and 93% on admission and 97 and 99% at 3-4 h. Among patients aged 75 years and older, 63% had a positive HsTnT on admission, but only 39% of these had an ACS during hospital stay.
Conclusion:
Our data confirm that prolonged testing with HsTnT after 3-4 h does not improve diagnostic performance for ACS. However, although sensitivity for acute myocardial infarction was very good, sensitivity for ACS was insufficient to rule out ACS even at 6-7 h. Less than half of all recorded positive HsTnT were true positives. On the basis of these results, we find it unlikely that HsTnT has improved the diagnosis of ACS in the emergency care setting.
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