The Predictive Power of the 14–51 Ng/L High Sensitive Troponin T (hsTnT) Values for Predicting Cardiac Revascularization in a Clinical Setting
Background: high sensitive Troponin T (hsTnT) values between 14–50 ng/L represent a challenge in diagnosing acute coronary syndrome (ACS) at the Emergency Department (ED). The European Society for Cardiology (ESC) recommends a second hsTnT measurement 3 h later to distinguish between ACS and other c...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/23/7147 |
| _version_ | 1797462886184910848 |
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| author | Frank W. De Jongh Sjaak Pouwels Marjolein C. De Jongh Eric A. Dubois Ron H. N. van Schaik |
| author_facet | Frank W. De Jongh Sjaak Pouwels Marjolein C. De Jongh Eric A. Dubois Ron H. N. van Schaik |
| author_sort | Frank W. De Jongh |
| collection | DOAJ |
| description | Background: high sensitive Troponin T (hsTnT) values between 14–50 ng/L represent a challenge in diagnosing acute coronary syndrome (ACS) at the Emergency Department (ED). The European Society for Cardiology (ESC) recommends a second hsTnT measurement 3 h later to distinguish between ACS and other causes depending on the Δ hsTnT. Our study aims to evaluate the predictive power this approach in a clinical setting by following patients presenting at the ED with hsTnT values 14–51 ng/L. Materials and methods: patients presenting with chest pain or dyspnea and a hsTnT value between 14 and 50 ng/L at the Erasmus MC ED in 2012–2013 were included and retrospectively monitored for 90 days after initial presentation for the occurrence of a cardiac revascularization. Patient records were reviewed according to the standing protocol, which depended on the Δ hsTnT. The “event-group” consists of patients receiving cardiac revascularization within 90 days after the ED visit, whereas the “no event-group” consisted of patients without revascularization. Results: a total of 889 patients patient records were reviewed. After excluding out-of-hospital-cardia-arrests (60), non-cardiological chest pain (373) and incomplete follow-up (100), 356 patients remained for final analysis. In 207 patients, a second hsTnT was actually performed (58%). From these 207 patients, 68 (33%) had a Δ hsTnT ≥7 ng/L. In these patients, 37 (54%) experienced an event within 90 days. In the 139 patients with a Δ hsTnT < 7 ng/L, 23 (17%) presented with an event within 90 days. Conclusion: our study demonstrated a sensitivity of 62%, a specificity of 79%, a positive predicted value (PPV) of 54% and a negative predictive value (NPV) of 83% for using a 3-h Δ hsTnT ≥7 ng/L cut-off, related to risk of an event in 90 days following ED presentation. |
| first_indexed | 2024-03-09T17:43:53Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T17:43:53Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-b9b648e1b50e4c8da8cba9d1d3d233a52023-11-24T11:23:41ZengMDPI AGJournal of Clinical Medicine2077-03832022-12-011123714710.3390/jcm11237147The Predictive Power of the 14–51 Ng/L High Sensitive Troponin T (hsTnT) Values for Predicting Cardiac Revascularization in a Clinical SettingFrank W. De Jongh0Sjaak Pouwels1Marjolein C. De Jongh2Eric A. Dubois3Ron H. N. van Schaik4Department of Clinical Chemistry, Erasmus University Medical Center, 3015 GD Rotterdam, The NetherlandsDepartment of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, 5011 GB Tilburg, The NetherlandsDepartment of Cardiology, HAGA Hospital, 2545 AA The Hague, The NetherlandsDepartment of Clinical Chemistry, Erasmus University Medical Center, 3015 GD Rotterdam, The NetherlandsDepartment of Clinical Chemistry, Erasmus University Medical Center, 3015 GD Rotterdam, The NetherlandsBackground: high sensitive Troponin T (hsTnT) values between 14–50 ng/L represent a challenge in diagnosing acute coronary syndrome (ACS) at the Emergency Department (ED). The European Society for Cardiology (ESC) recommends a second hsTnT measurement 3 h later to distinguish between ACS and other causes depending on the Δ hsTnT. Our study aims to evaluate the predictive power this approach in a clinical setting by following patients presenting at the ED with hsTnT values 14–51 ng/L. Materials and methods: patients presenting with chest pain or dyspnea and a hsTnT value between 14 and 50 ng/L at the Erasmus MC ED in 2012–2013 were included and retrospectively monitored for 90 days after initial presentation for the occurrence of a cardiac revascularization. Patient records were reviewed according to the standing protocol, which depended on the Δ hsTnT. The “event-group” consists of patients receiving cardiac revascularization within 90 days after the ED visit, whereas the “no event-group” consisted of patients without revascularization. Results: a total of 889 patients patient records were reviewed. After excluding out-of-hospital-cardia-arrests (60), non-cardiological chest pain (373) and incomplete follow-up (100), 356 patients remained for final analysis. In 207 patients, a second hsTnT was actually performed (58%). From these 207 patients, 68 (33%) had a Δ hsTnT ≥7 ng/L. In these patients, 37 (54%) experienced an event within 90 days. In the 139 patients with a Δ hsTnT < 7 ng/L, 23 (17%) presented with an event within 90 days. Conclusion: our study demonstrated a sensitivity of 62%, a specificity of 79%, a positive predicted value (PPV) of 54% and a negative predictive value (NPV) of 83% for using a 3-h Δ hsTnT ≥7 ng/L cut-off, related to risk of an event in 90 days following ED presentation.https://www.mdpi.com/2077-0383/11/23/7147high sensitive troponin ThsTnTcardiac revascularizationmyocardial infarctionACSnon-STEMI |
| spellingShingle | Frank W. De Jongh Sjaak Pouwels Marjolein C. De Jongh Eric A. Dubois Ron H. N. van Schaik The Predictive Power of the 14–51 Ng/L High Sensitive Troponin T (hsTnT) Values for Predicting Cardiac Revascularization in a Clinical Setting Journal of Clinical Medicine high sensitive troponin T hsTnT cardiac revascularization myocardial infarction ACS non-STEMI |
| title | The Predictive Power of the 14–51 Ng/L High Sensitive Troponin T (hsTnT) Values for Predicting Cardiac Revascularization in a Clinical Setting |
| title_full | The Predictive Power of the 14–51 Ng/L High Sensitive Troponin T (hsTnT) Values for Predicting Cardiac Revascularization in a Clinical Setting |
| title_fullStr | The Predictive Power of the 14–51 Ng/L High Sensitive Troponin T (hsTnT) Values for Predicting Cardiac Revascularization in a Clinical Setting |
| title_full_unstemmed | The Predictive Power of the 14–51 Ng/L High Sensitive Troponin T (hsTnT) Values for Predicting Cardiac Revascularization in a Clinical Setting |
| title_short | The Predictive Power of the 14–51 Ng/L High Sensitive Troponin T (hsTnT) Values for Predicting Cardiac Revascularization in a Clinical Setting |
| title_sort | predictive power of the 14 51 ng l high sensitive troponin t hstnt values for predicting cardiac revascularization in a clinical setting |
| topic | high sensitive troponin T hsTnT cardiac revascularization myocardial infarction ACS non-STEMI |
| url | https://www.mdpi.com/2077-0383/11/23/7147 |
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