title: Prognostic Value of Undetectable hs Troponin T in Suspected Acute Coronary Syndrome.
abstract: BACKGROUND
  The search for improved strategies for safe and early discharge of patients with suspected acute coronary syndrome in emergency departments is ongoing. This Biomarkers in Cardiology (BIC)-8 biomarker substudy evaluated the usefulness of high-sensitivity troponin T (hsTnT) below or above the limit of detection (LoD) in low-to-intermediate-risk patients with suspected acute coronary syndrome in the emergency department.
  
  
  METHODS
  Patients were categorized into hsTnT ≥ the 99th percentile, between the 99th percentile and LoD, or undetectable hsTnT (<LoD). HsTnT and copeptin were measured at admission, using a copeptin cut-off of 10 pmol/L. The primary endpoint was death and myocardial infarction within 90 days after admission.
  
  
  RESULTS
  Of 882 patients with all biomarker results, 577 (65.4%) had detectable hsTnT levels (≥LoD). Among the 305 patients (34.6%) with undetectable hsTnT, no myocardial infarctions or deaths occurred within 90 days. In patients with detectable hsTnT at admission (≥LoD but ≤99th percentile), the combined endpoint occurred in 1.5% (6/410) of the copeptin-negative patients and in 6.3% (6/96) of copeptin-positive patients within 90 days (hazard ratio 4.39; 95% confidence interval, 1.42-13.61; P = .01). In patients with an initially elevated hsTnT (≥14 ng/L), 9.7% (3/31) of the copeptin-negative patients and 15.4% (4/26) of the copeptin-positive patients experienced the combined endpoint (hazard ratio 1.61; 95% confidence interval, 0.36-7.17; P = .536).
  
  
  CONCLUSIONS
  In low-to-intermediate-risk patients with suspected acute coronary syndrome, undetectable hsTnT values at admission allow a safe discharge without occurrence of death or myocardial infarction within 90 days.
authors.affiliation: Department of Angiology, Cardiology and Pneumology, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Mehrshad
authors.initials: M
authors.lastname: Vafaie
authors.affiliation: Department of Cardiology, Division of Emergency Medicine, Charité Universitätsmedizin Berlin (Campus Virchow Klinikum and Campus Charité Mitte), Berlin, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Slagman
authors.affiliation: Department of Cardiology, Division of Emergency Medicine, Charité Universitätsmedizin Berlin (Campus Virchow Klinikum and Campus Charité Mitte), Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Möckel
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany; Medical Clinic I, Cardiology and Angiology, University of Giessen, Giessen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Hamm
authors.affiliation: Department of Cardiology and Internal Emergency Medicine, Wilhelminenspital, Vienna, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.affiliation: Department of Cardiology, University Hospital Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.affiliation: Clinical Diagnostics, Thermo Fisher Scientific, B.R.A.H.M.S GmbH, Hennigsdorf, Germany.
authors.forename: Jörn O
authors.initials: JO
authors.lastname: Vollert
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: Department of Angiology, Cardiology and Pneumology, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Liebetrau
authors.affiliation: Department of Angiology, Cardiology and Pneumology, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.affiliation: Department of Cardiology, Division of Emergency Medicine, Charité Universitätsmedizin Berlin (Campus Virchow Klinikum and Campus Charité Mitte), Berlin, Germany. Electronic address: Julia.searle@charite.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Searle
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006020:Glycopeptides / Q000097:blood; D006801:Humans; D057230:Limit of Detection; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010343:Patient Admission; D011379:Prognosis; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D020107:Troponin T; C048197:copeptins
keywords: Acute coronary syndrome (ACS); Acute myocardial infarction (AMI); Copeptin; High-sensitivity troponin T (hsTnT); Limit of detection (LoD); Rule-out