title: Prognostic performance of kinetic changes of high-sensitivity troponin T in acute coronary syndrome and in patients with increased troponin without acute coronary syndrome.
abstract: BACKGROUND
  We sought to evaluate the prognostic impact of absolute and relative kinetic changes of high-sensitivity cardiac Troponin T (hs-cTnT) in comparison to baseline hs-cTnT elevations for risk stratification in acute coronary syndrome (ACS) and non-ACS conditions with increased hs-cTnT.
  
  
  METHODS
  hs-cTnT was measured serially in patients presenting with acute symptoms to our emergency department. We assessed the prognostic performance of baseline and serial hs-cTnT concentrations in all consecutive patients with ACS (n=406) or hs-cTnT increases not due to ACS (n=442) within 3-6h after admission.
  
  
  RESULTS
  Mortality rates were higher, albeit not statistically, in non-ACS (53/442=12.0%) than ACS patients (36/406=8.9%). In ACS patients, receiver operating characteristics (ROC) revealed optimized cut-off values of 12.2 ng/L for absolute δ-change (AUC=0.66, p<0.001), 31.2 ng/L for baseline hs-cTnT (AUC=0.71, p<0.001) and 45.2 ng/L for maximal hs-cTnT (AUC=0.68, p<0.001). C-statistics showed superiority of absolute δ-changes (p=0.0003), baseline hs-cTnT (p=0.04) and maximal hs-cTnT (p=0.02) compared to relative δ-changes. However, the combination of baseline hs-cTnT values with either absolute or relative δ-changes did not improve risk prediction compared to baseline hs-cTnT alone (p=n.s.). In non-ACS conditions, the ROC-optimized cut-off value of 46.2 ng/L for baseline hs-cTnT (AUC=0.661, p<0.001) was superior to absolute (p=0.007) and relative δ-changes regarding prognostication (p=0.045).
  
  
  CONCLUSIONS
  Our data suggest that the magnitude of baseline hs-cTnT, and not acute dynamic changes, convey superior long-term prognostic information in ACS and non-ACS conditions. Moreover, absolute and relative kinetic δ-changes of hs-cTnT do not add significant incremental value in risk assessment in both conditions.
authors.affiliation: Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Mueller
authors.affiliation: Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Biener
authors.affiliation: Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Germany.
authors.forename: Mershad
authors.initials: M
authors.lastname: Vafaie
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.affiliation: Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Germany.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.affiliation: Department of Internal Medicine III, Cardiology, University Hospital Heidelberg, Germany.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: ACS; High-sensitivity troponin T; Kinetic changes; Non-ACS; Prognosis