Abstract 5023: Correlates of High Sensitivity Troponin T Concentrations in Chest Pain Patients With and Without Acute Coronary Syndrome
Background: For evaluation of chest pain, consensus guidelines recommend use of a cardiac troponin cut-point that corresponds to the 99th percentile of a healthy population. “High sensitivity” troponin (hsTn) assays provide good accuracy to this very low level, but cardiac structure and function correlates of hsTn concentrations in patients with acute chest pain are not well understood.
Methods: 377 patients (mean age 53.7 years, 64.2% male) with chest pain and low-to-intermediate likelihood for acute coronary syndrome (ACS) were enrolled in the emergency department. Blood was tested using a pre-commercial hsTnT assay (Roche Diagnostics). Simultaneous cardiac computed tomography (CT) imaging was performed using a 64-slice scanner (Sensation 64, Siemens Medical Solutions).
Results: 37 patients (9.8%) had an acute coronary syndrome (ACS). Using the 99th percentile cut-point of 13 pg/mL, hsTnT had 62% sensitivity and 89% specificity for ACS. Predictors of hsTnT values in all subjects included age (β = .019; P =.005), number of coronary segments (β = .324; P = .03) or coronary vessels (β = .634; P = .004) with significant stenosis, LV mass (β = .008; P < .001), LV ejection fraction (β = .042; P = .04), regional LV dysfunction (β = .669; P < .001), and NT-proBNP levels (β = .001; P = .009). Among patients without ACS (N=340), an hsTnT above 13 pg/mL identified those with more complex medical histories, more prevalent CAD and abnormalities of cardiac size and function (Table⇓).
Conclusions: Among patients with chest pain, concentrations of hsTnT identify patients with more significant risk profiles and more extensive structural heart disease, even in patients without the diagnosis of ACS.