Abstract
IntroductionCurrent evidence suggests that high sensitivity cardiac troponin-T (hs-cTnT) values differ based on sex, race, age, and kidney function. However, most studies examining the relationship of hs-cTnT and these individual factors are in healthy participants, leading to difficulty in interpreting hs-cTnT values in the Emergency Department (ED) setting. We seek to examine the relationship between hs-cTnT values and sex, race, age, and kidney function in a contemporary, urban academic setting.MethodsED visits from June 2018 through April 2019 with at least 1 hs-cTnT and no diagnosis of acute myocardial infarction (AMI) at an academic medical center in the south side of Chicago were retrospectively analyzed. Median hs-cTnT values were stratified by sex (male or female), race (African American or Caucasian), age, estimated glomerular filtration rate (eGFR), and stage of chronic kidney disease.Results 9679 encounters, representing 7989 distinct patients, were included for analysis (age 58 ± 18 years, 59% female, 85% black). Males had significantly higher median hs-cTnT values than females (16 [8–34] vs. 9 [6–22] ng/L, p < 0.001), African Americans had a significantly lower median value than Caucasians (10 [6–24] vs. 15 [6–29] ng/L, p < 0.001), and those with atrial fibrillation (27 [16–48] vs. 9 [6–19] ng/L, p < 0.001) and heart failure (28 [14–48] vs. 8 [6–15] ng/L, p < 0.001) had higher median values than those without. Median hs-cTnT values increased significantly with increased age and decreased eGFR. All relationships continued to be significant even after multivariable regression of sex, age, race, eGFR, presence of atrial fibrillation, and presence of heart failure (p < 0.01).ConclusionsAnalysis of hs-cTnT in non-AMI patients during ED encounters showed that males have higher values than females, African Americans have lower values than Caucasians, those with atrial fibrillation and heart failure have higher values than those without, and that older age and lower eGFR were associated with higher median values.
Highlights
Current evidence suggests that high sensitivity cardiac troponin-T values differ based on sex, race, age, and kidney function
We describe the ranges of high sensitivity cardiac troponin-T (hs-cTnT) in Emergency Department (ED) visits across sex, race, age, estimated glomerular filtration rate, and presence of heart failure or atrial fibrillation in patients without acute myocardial infarctions (AMI) during usual clinical care
Patients with repeated encounters within 14 days, trauma, cardiac arrest, left ventricular assist devices (LVAD), history of heart transplant, patients without an estimated glomerular filtration rate (eGFR) value, and patients diagnosed with AMI during the encounter were excluded from analysis (Fig. 1)
Summary
Current evidence suggests that high sensitivity cardiac troponin-T (hs-cTnT) values differ based on sex, race, age, and kidney function. Most studies examining the relationship of hs-cTnT and these individual factors are in healthy participants, leading to difficulty in interpreting hs-cTnT values in the Emergency Department (ED) setting. We seek to examine the relationship between hs-cTnT values and sex, race, age, and kidney function in a contemporary, urban academic setting. Since the approval of the high-sensitivity cardiac troponin-T (hs-cTnT) assay by the US Food and Drug Administration in 2017 for clinical care, there has been renewed interest in determining blood concentrations in individuals without acute myocardial infarctions (AMI) [1, 2]. Clinicians often have difficulty interpreting hs-cTnT values in the setting of individual patient factors, such as older patients with chronic kidney disease (CKD) [7, 8].
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