Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
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Super sensitivity cardiac Troponin I compared to high sensitivity cardiac Troponin I to predict risk in patients with suspected chronic coronary syndrome
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K. Imelmann1, B. von Jeinsen2, D. Grün3, J. S. Wolter2, S. Kriechbaum2, O. Dörr4, H. Nef4, C. W. Hamm4, C. Liebetrau5, T. Keller6
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1Kardiologie und Angiologie, Justus-Liebig-Universität Giessen, Gießen; 2Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim; 3Medizinische Klinik I, Innere Medizin / Kardiologie, Justus-Liebig-Universität Giessen, Gießen; 4Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Gießen; 5CCB am AGAPLESION BETHANIEN KRANKENHAUS, Frankfurt am Main; 6Franz-Groedel-Institut (FGI), Justus-Liebig-Universität Giessen, Bad Nauheim;
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Background and Aim: High sensitivity cardiac Troponin I (hs-cTnI) is a well known risk predictor in patients with coronary artery disease as well as in the general population. Lately, super sensitivity cardiac Troponin I (ss-cTnI) assays have been established. The aim of the present investigation was to compare the predictive value of ss-cTnI with a hs-cTnI assay in patients with suspected chronic coronary syndrome.
Methods: We investigated 1367 patients (mean age 68.9 years, n=430 (31.5%) females) with suspected chronic coronary syndrome, who were enrolled in a multi-center, prospective biomarker registry. Patients were enrolled at the Kerckhoff Heart and Thorax Center in Bad Nauheim and the University Hospital of the Justus-Liebig-University in Gießen. Follow-up data was available in 1322 patients (96.7%). The primary endpoint overall mortality was reached in n=377 patients. Ss-cTnI and hs-cTnI were measured at baseline. To compare the predictive value of hs-cTnI and ss-cTnI regarding the primary endpoint of death, we performed a receiver operating characteristics (ROC) analyses in the overall cohort and additionally in patients with normal troponin values according to the hs-cTnI assay (below the sex-specific 99th percentile; female: 15.6 ng/L, male: 34.2 ng/L).
Results: In the overall cohort, patients with higher ss-cTnI were older (p<0.001), had more renal failure (p <0.001), had a higher rate of coronary artery disease (p<0.001), higher HbA1c-values (p=0.001), a higher rate of arterial hypertension (p<0.001) and diabetes (p=0.006) and mortality was documented more frequently (p<0.001). The ROC analysis in the overall cohort showed an area under the curve (AUC) of 0.725 (0.695-0.754) for hs-cTnI with respect to the primary endpoint of death and a slightly higher AUC of 0.743 (0.716-0.770) for ss-cTnI (pAUCdiff=0.238). In the subcohort of individuals with hs-cTnI in the normal range, ss-cTnI predicted mortality with an AUC of 0.731 (0.699-0.763) also slightly higher than hs-cTnI with an AUC of 0.720 (0.689-0.752) also without reaching a statistical significance (pAUCdiff =0.239).
Conclusion: Higher troponin I levels measured with a high or a super sensitive assay are associated with a higher rate of cardiac risk factors and are associated with an unfavorable outcome. However, ss-cTnI was not superior compared to hs-cTnI predicting overall mortality.
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https://dgk.org/kongress_programme/jt2022/aP2007.html
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