Skip to main content

ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Precision Cardiology
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1450619

Prognostication in emergency room patients: Comparing ultrasensitive and contemporary quantification of cardiac troponin levels below the 99th percentile

Provisionally accepted
Anna Carrasquer Anna Carrasquer Germán Cediel Germán Cediel Alma Gómez-Sanz Alma Gómez-Sanz *Óscar M Peiró Óscar M Peiró Isabel Fort-Gallifa Isabel Fort-Gallifa Alfredo Bardaji Alfredo Bardaji *Jose Luis Ferreiro Jose Luis Ferreiro *
  • Joan XXIII University Hospital of Tarragona, Tarragona, Spain

The final, formatted version of the article will be published soon.

    Introduction. Cardiac troponin levels below the 99th percentile improve the predictive efficacy for cardiovascular events when associated with relevant clinical variables. However, whether ultra-sensitive analytical methods improve this predictive efficacy over less sensitive or contemporary analytical methods remains unknown. Methods. This retrospective observational study involved consecutive patients who presented to the emergency department for suspected acute coronary syndrome and underwent measurement of ultra-sensitive cardiac troponin I (Singulex) and contemporary cardiac troponin I (Siemens) with levels below the 99th percentile. The clinical characteristics of these patients were analysed, and the efficacy of both analytical methods for predicting cardiovascular events over a 4-year follow-up period was compared. Results. In total, 838 patients were analysed (mean age, 62.9 ± 16.6 years; 42.2% women). Their cumulative incidence of the composite cardiovascular event (death, readmission for myocardial infarction, and readmission for heart failure) was 25.9% over the 4-year follow-up. Both Singulex cardiac troponin I (analysed by quartiles) and Siemens cardiac troponin (analysed as detectable/undetectable) improved the predictive efficacy for the combined event over clinical variables [Harrell’s C-index (95% confidence interval): 0.77 (0.74–0.80) vs. 0.79 (0.76–0.81) and 0.77 (0.74–0.80) vs. 0.78 (0.75–0.81), respectively; p = 0.018]. However, there were no statistically significant difference between the two predictive models that included the aforementioned troponin assays. Conclusions. Detectable levels of cardiac troponin using a contemporary analytical method or those near the 99th percentile using an ultra-sensitive analytical method improve the predictive efficacy for cardiovascular events, with no differences between the two methods.

    Keywords: AMI, Acute Myocardial Infarction, cTn, cardiac troponin 2, Troponin, prognosis, Mortality, Heart Failure

    Received: 04 Oct 2024; Accepted: 16 Dec 2024.

    Copyright: © 2024 Carrasquer, Cediel, Gómez-Sanz, Peiró, Fort-Gallifa, Bardaji and Ferreiro. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Alma Gómez-Sanz, Joan XXIII University Hospital of Tarragona, Tarragona, Spain
    Alfredo Bardaji, Joan XXIII University Hospital of Tarragona, Tarragona, Spain
    Jose Luis Ferreiro, Joan XXIII University Hospital of Tarragona, Tarragona, Spain

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.