High Baseline High-Sensitivity Cardiac Troponin T Concentrations and Risk of Index Acute Myocardial Infarction.

Area of Science:

• Cardiology
• Emergency Medicine
• Biomarker Diagnostics

Background:

• Accurate risk stratification is crucial for acute myocardial infarction (AMI) diagnosis.
• High-sensitivity cardiac troponin T (hs-cTnT) is a key biomarker for AMI.
• Established hs-cTnT thresholds require validation in diverse patient populations.

Purpose of the Study:

• To evaluate the diagnostic performance of hs-cTnT thresholds (52 and 100 ng/L) for identifying high-risk AMI patients.
• To compare the positive predictive value (PPV) of these thresholds across different patient cohorts.
• To assess the utility of hs-cTnT in emergency department settings.

Main Methods:

• Retrospective analysis of two large cohorts: MAyo Southwest Wisconsin (n=2053) and CV Data Mart Biomarker (n=143,709).
• Comparison of PPV for index AMI using hs-cTnT thresholds of >52 ng/L and >100 ng/L.
• Stratification of analysis for patients with and without chest discomfort/pain.

Main Results:

• In the MAyo cohort, hs-cTnT >52 ng/L had a PPV of 41% and >100 ng/L had a PPV of 57% for AMI.
• In patients with chest discomfort (MAyo cohort), PPVs increased to 66% (>52 ng/L) and 77% (>100 ng/L).
• In the larger CV Data Mart cohort, PPVs were significantly lower: 12% (>52 ng/L) and 17% (>100 ng/L), with chest pain patients showing 17% and 22% PPVs, respectively.

Conclusions:

• The evaluated hs-cTnT thresholds (52 and 100 ng/L) demonstrate suboptimal performance for identifying high-risk AMI in unselected emergency department patients.
• An hs-cTnT threshold >100 ng/L shows acceptable performance for AMI diagnosis in patients with chest discomfort, but requires integration with clinical assessment.
• The European Society of Cardiology-recommended threshold of >52 ng/L appears insufficient for high-risk AMI identification in these cohorts.