Abstract 15468: Age- and Gender-specific 99th Percentile Cut-offs for Diagnosis of Myocardial Infarction and Prognostic Implications - Results From the High Sensitivity Cardiac Troponin T Assay for Rapid Rule-out of Acute Myocardial Infarction Substudy
Objective: We aimed to evaluate the impact of age- and gender-specific cut-offs in comparison to the general 99th percentile cut-off for diagnosis and prognosis of acute myocardial infarction (AMI).
Methods: 1282 unselected patients presenting with suspected AMI and recent (<6h) onset of chest pain to the emergency department were enrolled as part of the TRAPID-AMI study and 359 patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) qualified for further subanalysis. Patients were classified using age- and gender-dependent hs-TnT 99th percentile cut-off values previously described in literature (28 ng/L for ≥65y, 9 ng/L for female and 15.5 ng/L for male patients) in comparison to the general cut-off of 14 ng/L.
Results: Table 1 displays changes regarding diagnostic reclassification and outcomes when comparing age-specific and general 99th percentile cut-off values in NSTE-ACS patients with age ≥65y (n=216). Significant reclassification concerning 1-month and 3-month mortality could be observed using net reclassification improvement (p<0.001, respectively). In contrast to the general cut-off, the age-specific cut-off also revealed a significant distribution for the combined endpoint of death/MI after 12 months with chi-square analysis (p=0.03). Using gender-specific cut-offs, diagnostic reclassification was made in 4.7% (17/359), with AMI rate increasing from 58/93 (62.4%) to 67/93 (72.0%) in female, while AMI rates decreased from 125/266 (47.0%) to 117/266 (44.0%) in male patients. No significant differences in outcome data could be found between patients classified for general and gender-specific cut-offs.
Concusions: Gender-and age-specific cut-offs may be implemented in future guidelines. However, while age showed a significant impact on reclassification of diagnosis and outcomes, influence of gender-specific cut-offs was only modest.
Author Disclosures: M. Mueller: None. B. Lindahl: Research Grant; Modest; Roche Diagnostics, Fiomidiagnostics AB and bioMérieux Clinical Diagnostics. Honoraria; Modest; Thermo Fisher. Consultant/Advisory Board; Modest; Roche Diagnostics, Beckman Coulter Inc., Siemens Healthcare Diagnostics, Radiometer Medical, bioMérieux Clinical Diagnostics, Philips Healthcare, Fiomidiagnostics AB. E. Giannitsis: Research Grant; Modest; Roche Diagnostics. Honoraria; Modest; Roche Diagnostics, BRAHMS Thermo Fisher, and Mitsubishi Chemical Europe. Consultant/Advisory Board; Modest; Roche Diagnostics and BRAHMS Thermo Fisher. H.A. Katus: Honoraria; Modest; AstraZeneca, Eli Lilly and Company, GlaxoSmithKline, Roche, and Bayer HealthCare. Other; Modest; holds a patent jointly with Roche and receives royalties for this patent. S. Weiser: Employment; Significant; Roche Diagnostics. G. Bendig: Employment; Significant; Roche Diagnostics. P. Dilba: Employment; Significant; Roche Diagnostics GmbH. C. Mueller: Other Research Support; Modest; European Union, the Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, Abbott, Alere, BRAHMS, Nanosphere, Roche, Siemens, Department of Internal Medicine, University Hospital Basel. Honoraria; Modest; Abbott, Alere, Astra-Zeneca, BG-medicine, bioMérieux Clinical Diagnostics, BRAHMS, Cardiorentis, Lilly, Novartis, Radiometer, Roche, and Siemens. Consultant/Advisory Board; Modest; Abbott, Alere, Astra-Zeneca, BG-medicine, bioMérieux Clinical Diagnostics, BRAHMS, Cardiorentis, Lilly, Novartis, Radiometer, Roche, and SiemensCardiorentis, Lilly, Novartis, Radiometer, Roche, and Siemens.
- © 2014 by American Heart Association, Inc.