Diagnostic and prognostic implications using age- and gender-specific cut-offs for high-sensitivity cardiac troponin
Matthias Mueller-Hennessen1, Bertil Lindahl2, Evangelos Giannitsis1
1Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.
Insights
Age-specific high-sensitivity cardiac troponin T (hs-cTnT) cut-offs significantly impact acute myocardial infarction (AMI) diagnosis and prognosis. Gender-specific cut-offs had a modest effect, suggesting age-based thresholds warrant further validation in suspected AMI cases.
Area of Science:
- Cardiology
- Biomarkers
- Diagnostic Accuracy
Background:
- High-sensitivity cardiac troponin T (hs-cTnT) is crucial for diagnosing acute myocardial infarction (AMI).
- Current diagnostic criteria often use a general 99th percentile cut-off for hs-cTnT.
- Age and gender may influence hs-cTnT levels, potentially affecting diagnostic accuracy.
Purpose of the Study:
- To compare the diagnostic and prognostic impact of age- and gender-specific hs-cTnT cut-offs versus the general 99th percentile cut-off for AMI.
- To assess reclassification of AMI diagnosis and patient outcomes using different hs-cTnT threshold strategies.
Main Methods:
- Analysis of 1282 patients presenting with suspected AMI from the TRAPID-AMI study.
- Reclassification of AMI diagnosis using a general hs-cTnT cut-off (14 ng/L) versus age- (≥65 years) and gender-specific cut-offs.
- Clinical adjudication of patients into acute coronary syndrome (ACS) and non-ACS categories.
Main Results:
- Age-specific cut-offs significantly reduced AMI diagnosis rates in older patients (≥65 years) and improved 1-month and 3-month mortality reclassification (14.2% net reclassification improvement).
- Gender-specific cut-offs showed varied effects: increased AMI rates in women, decreased rates in men, but no significant impact on outcomes.
- No significant differences in patient outcomes were observed when using gender-specific hs-cTnT cut-offs.
Conclusions:
- Age-specific hs-cTnT cut-offs significantly reclassify patients for AMI diagnosis and prognosis, demonstrating a substantial impact.
- Gender-specific hs-cTnT cut-offs had a modest influence on diagnostic and prognostic reclassification in suspected AMI.
- Age-specific hs-cTnT cut-offs show promise and warrant further validation for clinical application.
Objectives:
To evaluate the impact of age- and gender-specific cut-offs for high-sensitivity cardiac troponin T (hs-cTnT) compared to the general 99th percentile hs-cTnT cut-off on diagnosis and prognosis of acute myocardial infarction (AMI).
Methods:
1282 unselected patients presenting to the emergency department with suspected AMI were enrolled as part of the TRAPID-AMI study. In the present sub-analysis, reclassification of AMI diagnosis was performed by comparing the general hs-cTnT cut-off of 14ng/L to previously proposed age- and gender-dependent hs-cTnT 99th percentile cut-offs (28ng/L for ≥65years, 9ng/L for female and 15.5ng/L for male patients). Patients were further clinically adjudicated into acute coronary syndrome (ACS) and non-ACS.
Results:
For patients ≥65years, application of age-specified cut-offs resulted in a decrease of AMI from 29.8% to 18.3% in the entire cohort (n=557) and 54.7% to 40.9% in the ACS subcohort (n=225). Using gender-specific cut-offs, AMI-rate increased from 16.6% to 22.6% (entire cohort, n=477) and 62.6% to 71.7% (ACS subcohort, n=99) in women, whereas in men, rates decreased from 23.1% to 21.1% (entire cohort, n=805) and 48.8% to 45.9% (ACS, n=281), respectively. Age-specified cut-offs significantly reclassified patients for outcomes of 1-month and 3-month mortality in the entire and ACS cohort (14.2% net reclassification improvement, p<0.001, respectively). Contrary, no significant differences in outcomes could be found using gender-specific cut-offs.
Conclusions:
While influence of gender-specific hs-cTnT cut-offs on diagnostic and prognostic reclassification was only modest in patients with suspected AMI, age-specific cut-offs showed a significant impact and may be considered for further validation.
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