Abstract 16450: The 99th Percentile of High-Sensitivity Assayed Troponin I is Associated With a High Risk of Death in Patients With Acute Chest Pain
Background: The use of high-sensitivity assayed troponin allows measuring troponin concentrations far below the 99th percentile and enables rapid procedures to rule out acute myocardial infarction (AMI) with lower troponin cut-offs.
Objective: To compare follow-up events of patients with acute onset chest pain and ruled out AMI by either a recently published “rapid algorithm” using a high-sensitivity cardiac troponin I (hs-TnI) cut-off of 6 ng/L at 0h and 1h or the 99th percentile of that assay (27ng/L) at 0h and 3h (“standard of care”).
Methods: Hs-TnI was measured in 1,216 patients presenting to the chest pain unit of a German tertiary care center on admission (0h), after 1h and 3h. Patients with ST-elevation AMI were excluded. Follow-up was performed at 30 days, 6, 12 and 24 months. Overall mortality and cardiac rehospitalization were assessed.
Results: The median follow-up time was 525 days. Patients ruled out by the “rapid algorithm” showed less cardiac rehospitalizations after 24 months (18.8% vs 23.6%, p=0,003; Figure 1A). All-cause mortality was significantly higher in patients ruled out by the “standard of care” with the 99th percentile as cut-off (5.1% vs 7.0%, p=0.011; Figure 1B).
Conclusion: The 99th percentile of high-sensitivity assayed troponin I as cut-off to rule out AMI neglects individuals with a high mortality risk.
Author Disclosures: N.A. Sörensen: None. J.T. Neumann: None. F.M. Ojeda: None. T.F. Schwemer: None. R.B. Schnabel: None. T. Renné: None. T. Zeller: None. M. Karakas: None. S. Blankenberg: Honoraria; Modest; Abbott Diagnostics, Siemens, Thermo Fisher, Roche Diagnostics. Consultant/Advisory Board; Modest; Thermo Fisher. D. Westermann: None.
- © 2016 by American Heart Association, Inc.