Using higher cut-off values to diagnose acute myocardial infarction in patients with elevated hs-cTnT

Area of Science:

• Cardiology
• Biomarkers
• Diagnostic Accuracy

Background:

• Diagnosing acute myocardial infarction (AMI) can be difficult in patients with elevated high-sensitivity cardiac troponin T (hs-cTnT) without observing a significant change.
• Elevated hs-cTnT levels are common, necessitating refined diagnostic criteria.

Purpose of the Study:

• To determine optimal predictive cut-off values for ruling in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) in patients with elevated hs-cTnT.
• To assess the diagnostic accuracy of these cut-offs in a large Chinese patient cohort.

Main Methods:

• Retrospective analysis of 76,411 patients with elevated hs-cTnT.
• Utilized receiver operating characteristic (ROC) curves and area under the curve (AUC) to identify optimal diagnostic cut-offs.
• Compared hs-cTnT levels between STEMI, NSTEMI, and non-cardiac disease groups.

Main Results:

• The optimal cut-off for STEMI diagnosis was 251.9 ng/L (AUC: 0.942, sensitivity: 90.7%, specificity: 86.5%).
• The optimal cut-off for NSTEMI diagnosis was 130.5 ng/L (AUC: 0.638, sensitivity: 40.9%, specificity: 83.8%).
• STEMI patients had a median hs-cTnT of 3788.0 ng/L, while NSTEMI patients had a median of 67.2 ng/L.

Conclusions:

• Optimized hs-cTnT cut-off values of 251.9 ng/L for STEMI and 130.5 ng/L for NSTEMI demonstrate high diagnostic accuracy.
• These refined cut-offs can aid in the timely diagnosis of AMI in patients with elevated hs-cTnT.
• The findings are validated in a large cohort of Chinese patients, supporting their clinical utility.