Abstract
High-sensitivity troponin has proven to be a promising biomarker for the prediction of future adverse cardiovascular events. We aimed to assess the prognostic value of high-sensitivity troponin I (hs-TnI) on admission in patients with suspected acute myocardial infarction (AMI) analyzed by a novel (Singulex Clarity cTnI) and established hs-TnI assay (ARCHITECT STAT hs-TnI, Abbott). Hs-TnI was measured in a total of 2332 patients from two prospective cohort studies presenting to the emergency department with suspected AMI. The prognostic impact for overall and cardiovascular mortality of both hs-TnI assays was assessed in the total patient cohort as well as in the subgroups of patients with AMI (n = 518) and without AMI (non-AMI) (n = 1814). Patients presenting with highest hs-TnI levels showed higher overall and cardiovascular mortality rates compared to those with lower troponin levels, irrespective of the assay used. Both hs-TnI assays indicated association with overall mortality according to adjusted hazard ratio (HR) among the entire study population (HR for Singulex assay: 1.16 (95% CI 1.08–1.24) and HR for Abbott assay: 1.17 (95% CI 1.09–1.25)). This finding was particularly pronounced in non-AMI patients, whereas no association between hs-TnI and overall mortality was found in AMI patients for either assay. In non-AMI patients, both assays equally improved risk prediction for cardiovascular mortality beyond conventional cardiovascular risk factors. Hs-TnI is independently predictive for adverse outcomes in patients with suspected AMI, especially in the subset of patients without confirmed AMI. There was no difference between the established and the novel assay in the prediction of mortality.
Highlights
Cardiac troponin is a biomarker released by injured myocardial cells and, can be used to detect myocardial necrosis [1]
Median troponin levels analyzed by the Singulex assay were 2.3 ng/L among the whole cohort, as well as 88.3 ng/L and 1.6 ng/L, in acute myocardial infarction (AMI) and non-AMI patients, respectively
In non-AMI patients, hazard ratio (HR) was 1.38 for the Singulex assay and 1.44 for the Abbott assay
Summary
Cardiac troponin (cTn) is a biomarker released by injured myocardial cells and, can be used to detect myocardial necrosis [1]. Measurement of circulating cTn represents a key diagnostic tool in patients with suspected acute myocardial infarction (AMI) [2]. For the diagnosis of AMI, international guidelines recommend using high-sensitivity troponin I (hs-TnI) or T (hs-TnT). High-sensitivity assays are capable of determining troponin levels far below the. High-sensitivity assayed troponin, even at these lower concentrations, has been proven to be a reliant biomarker in the prediction of adverse cardiovascular events in the general population [7,8,9,10]. As well as in patients with suspected myocardial infarction [11,12,13]. The ability to predict mortality has been demonstrated for the assessment of both troponin subunits, cTnT and cTnI [9,14,15,16]
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