title: Comparison of prognostic value of high-sensitivity and conventional troponin T in patients with non-ST-segment elevation acute coronary syndromes.
abstract: BACKGROUND
  The impact of high-sensitivity troponin assays on risk stratification of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is unknown.
  
  
  METHODS
  The study included 447 patients with NSTE-ACS. Cardiac troponin T (TnT) was measured with conventional and high-sensitivity assays, in parallel, using the same plasma sample. The primary end-point was 4-year mortality.
  
  
  RESULTS
  The use of cut-off of 0.014 μg/L of high-sensitivity TnT (hs-TnT) instead of 0.01 μg/L of the conventional (cTnT) increased proportion of non-ST-segment elevation myocardial infarction (NSTEMI) patients by 33% (from 201 to 268 patients). Re-classified patients from unstable angina to NSTEMI had similar 4-year mortality compared to patients with NSTEMI by both assays: 16 deaths (25.1%) among 67 re-classified patients versus 47 deaths (23.6%) among patients diagnosed with NSTEMI by both assays; odds ratio=1.03, 95% confidence interval [CI] 0.53-1.97; P=0.933). The Cox model identified hsTnT (hazard ratio=2.59, 95% CI 1.22-5.50; P=0.013 for hsTnT>0.014μg/L versus hsTnT ≤ 0.014 μg/L) as an independent correlate of 4-year mortality. hsTnT significantly improved prediction of the four-year mortality (relative integrated discrimination improvement 8.2%, P=0.005).
  
  
  CONCLUSIONS
  The use of hsTnT instead of cTnT increased the proportion of patients with NSTEMI among patients with NSTE-ACS and significantly improved risk stratification regarding long-term mortality.
authors.affiliation: Deutsches Herzzentrum, Technische Universität, Munich, Germany. ndrepepa@dhm.mhn.de
authors.forename: Gjin
authors.initials: G
authors.lastname: Ndrepepa
authors.forename: Siegmund
authors.initials: S
authors.lastname: Braun
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schulz
authors.forename: Robert A
authors.initials: RA
authors.lastname: Byrne
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pache
authors.forename: Julinda
authors.initials: J
authors.lastname: Mehilli
authors.forename: Albert
authors.initials: A
authors.lastname: Schömig
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T