Value of High-Sensitive Cardiac Troponin in Predicting Mortality in the Emergency Department
Insights
High-sensitivity cardiac troponin T (hs-cTnT) initial levels alone are insufficient for predicting cardiac mortality in emergency department patients with suspected acute coronary syndrome (ACS). However, hs-cTnT level changes correlate with mortality risk.
Area of Science:
- Cardiology
- Emergency Medicine
- Biomarkers
Background:
- Acute coronary syndrome (ACS) diagnosis in the emergency department (ED) requires accurate risk stratification.
- High-sensitivity cardiac troponin T (hs-cTnT) is a key biomarker for myocardial injury.
Purpose of the Study:
- To evaluate the predictive accuracy of initial hs-cTnT levels for mortality in patients with suspected ACS.
- To determine the utility of hs-cTnT reference values in predicting cardiac and all-cause mortality.
Main Methods:
- Retrospective analysis of 11,795 patients tested for hs-cTnT in the ED for suspected ACS.
- Mortality data (all-cause and cardiac) collected from a national mortality registry at one month.
- Area Under the Curve (AUC) calculated for initial hs-cTnT to assess predictive performance.
Main Results:
- Initial hs-cTnT showed good predictive value for one-month cardiac mortality (AUC 0.869) and all-cause mortality (AUC 0.861).
- The upper reference limit (14 ng/L) had 87% sensitivity but only 69% specificity for cardiac mortality.
- A significant correlation was observed between hs-cTnT level changes (absolute or relative) and mortality rates.
Conclusions:
- The reference value of initial hs-cTnT alone is not sufficiently accurate for predicting cardiac mortality in ACS patients.
- Trends in hs-cTnT levels (increases or decreases) are more indicative of mortality risk than a single threshold.
- Dynamic hs-cTnT measurements may offer improved prognostic value in suspected ACS.
Background:
The present study aimed to determine the validity of hs-cTnT in predicting the mortality among patients presented to the emergency department (ED) likely to be acute coronary syndrome (ACS).
Method:
Patients in whom hs-cTnT was tested in the ED for a possible ACS composed the study cohort. Hs-cTnT levels of the study patients were obtained from the hospital computerized database. The outcome and mortality of the study patients was detected using the digitalized national mortality registry. All-cause mortality and cardiac mortality at the end of one month was the primary outcome.
Results:
11795 patients were eligible for mortality detection and included into the final analysis. 1246 of 11795 patients were established to be dead during the study period and 358 of them supposed to be cardiac in origin. The Area Under the Curve (AUC) value of initial hs-cTnT for predicting one-month cardiac mortality was 0.869 (95% CI: 0.863 - 0.875) and 0.861 (95% CI: 0.855 - 0.867) for one-month all-cause mortality. The upper reference limit, 14 ng/L, has a sensitivity and specificity of 87% (95% CI: 77% to 94%) and 69% (95% CI: 68% to 70%), respectively, for predicting one-month cardiac mortality.
Conclusions:
The reference value of initial hs-cTnT does not have the ability to predict the cardiac mortality in a sufficient manner. However, reductions or increases in absolute or relative hs-cTnT levels are in concordance with mortality rates.
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