title: Reduced performance of Troponin T for acute coronary syndromes diagnosis in the elderly and very elderly patients: a retrospective study of 2688 patients.
abstract: OBJECTIVE
  We evaluated the performance of Troponin T (cTnT) for acute coronary syndrome (ACS) diagnosis in elder compared to younger patients.
  
  
  METHODS
  We retrospectively evaluated 2688 patients admitted to our Emergency Department for suspected ACS. All patients received ECG, serum creatinine determination, and serial cTnT samplings. Patients were considered positive for cTnT if they had a cTnT above our reference standard (>0.03 microg/L) in any determination obtained within 6 hours from admission. ACS diagnosis, either acute myocardial infarction or unstable angina, was based on reviewed data and discharge diagnosis hospital. Patients were divided in three groups according to age: <65-years-old, elders > or =65 and <80 years, and very elders > or =80 years. CTnT diagnostic accuracy for ACS was compared in these three groups in patients <65 years.
  
  
  RESULTS
  Two thousands six and hundred eighty-eight patients (35.3% female) were enrolled in this study. 1087 patients (40.4%) were <65 years old, while 1205 patients (44.8%) were >or =65 and <80 years, and 396 patients (14.8%) were > or =80 years. The overall sensitivity of cTnT for ACS diagnosis was 0.57 (CI 95% 0.54-0.60) with a specificity of 0.71 (CI 95% 0.69-0.73). In older cohorts cTnT showed a reduced performance for ACS diagnosis. Area under the receiver operating characteristic curve of abnormal cTnT for ACS was 0.70 (0.66-0.73) in <65 years, 0.61 (95% CI 0.60-0.66) in > or =65 and <80 years, and 0.59 (0.53-0.65) in > or =80 years.
  
  
  CONCLUSIONS
  Compared to younger patients cTnT showed a reduced performance for ACS diagnosis in elders > or =65 and <80 years; cTnT performance was further reduced in patients > or =80 years.
authors.affiliation: Department of Emergency Medicine, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy. macovino@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Covino
authors.forename: B
authors.initials: B
authors.lastname: Simeoni
authors.forename: M
authors.initials: M
authors.lastname: Montalto
authors.forename: F
authors.initials: F
authors.lastname: Burzotta
authors.forename: F
authors.initials: F
authors.lastname: Buccelletti
authors.forename: L
authors.initials: L
authors.lastname: Carbone
authors.forename: A
authors.initials: A
authors.lastname: Gallo
authors.forename: N
authors.initials: N
authors.lastname: Gentiloni Silveri
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007118:Immunoassay; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T; D003404:Creatinine