Predictive and prognostic value of different cardiac troponin assays: a nationwide register-based cohort study
Rasmus B Hasselbalch1,2, Martin Schultz1,2, Philip A Schytz1
1Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen 2730, Denmark.
Insights
Different cardiac troponin assays show varying predictive power for myocardial infarction and mortality in acute coronary syndrome patients. Siemens Vista cTnI best predicts MI, while high-sensitivity troponin T (hs-cTnT) best predicts mortality.
Area of Science:
- Cardiology
- Biomarkers
- Diagnostic Assays
Background:
- Current guidelines do not differentiate between available cardiac troponin (cTn) assays.
- Understanding the prognostic and predictive capabilities of different cTn assays is crucial for acute coronary syndrome (ACS) management.
- Variations in assay performance may impact clinical decision-making and patient outcomes.
Purpose of the Study:
- To compare the prognostic and predictive abilities of four different cardiac troponin assays.
- To evaluate the association between cTn concentrations and outcomes such as myocardial infarction (MI) and mortality.
- To investigate potential differences in assay performance in a large nationwide cohort.
Main Methods:
- Nationwide cohort study of 90,705 patients with ACS and at least two cTn measurements.
- Assays included: Roche high-sensitivity cTnT (hs-cTnT), Abbott high sensitivity cTnI (hs-cTnI), Siemens Vista cTnI, and Siemens cTnI Ultra.
- Statistical analyses included receiver operating characteristic curves and logistic regression to assess prediction of MI, and all-cause, cardiovascular, and non-cardiovascular mortality.
Main Results:
- Siemens Vista cTnI demonstrated the strongest prediction for MI (AUC 0.93).
- High-sensitivity troponin T (hs-cTnT) was the strongest predictor of cardiovascular mortality, with significantly increased odds at higher concentrations.
- An inverted U-shape relationship was observed between cTn concentration and non-cardiovascular mortality, indicating a complex association at different levels.
Conclusions:
- Significant differences exist in the prognostic and predictive abilities of various cTn assays.
- Siemens Vista cTnI is the most effective assay for predicting MI in ACS patients.
- Hs-cTnT shows the strongest association with mortality, with a complex relationship observed for non-cardiovascular causes.
Aims:
Guidelines do not differentiate between the available assays of cardiac troponin (cTn). We compared the prognostic and predictive ability of cTn assays.
Methods And Results:
This was a nationwide cohort study of patients with acute coronary syndrome (ACS) and ≥ 2 cTn measurements of one of four assays: Roche high-sensitivity cTnT (hs-cTnT), Abbott high sensitivity cTnI (hs-cTnI), Siemens Vista cTnI, and Siemens cTnI Ultra. Data were collected from Danish registries from 2009-18. Peak cTn concentration normalized to the 99th percentile was used. Outcomes were myocardial infarction (MI) during admission, one-year all-cause-, cardiovascular-, and non-cardiovascular mortality. Receiver operating characteristics and logistic regression calculating odds ratios (OR) were used. A total of 90 705 patients were included, of which 20 550 (23%) had MI. Siemens Vista cTnI was the strongest predictor of MI, Area under the curve (auc) 0.93 (95% CI 0.93-0.93). In 1 year 9012 (9.9%) of patients had died. An inverted U-shape relationship was observed between concentration of cTn and all-cause mortality. Hs-cTnT OR 21.3 (95% CI 18.4-24.8) at 2-5 times the 99th percentile and 12.1 (95% CI 10.3-14.1) for concentrations >100 times the 99th percentile. The inverted U-shape relationship was only present for non-cardiovascular mortality. The strongest predictor of cardiovascular mortality was hs-cTnT, OR 11.3 (95% CI 6.4-21.8) at 1-2 times the 99th percentile and 88.8 (95% CI 53.2-163.0) for concentrations >100 times the 99th percentile.
Conclusion:
Siemens Vista cTnI was the strongest predictor of MI and hs-cTnT was the strongest predictor of mortality. An inverted U-shape relationship was observed between cTn concentration and non-cardiovascular mortality.
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