High-sensitivity troponin T and long-term adverse cardiac events among patients presenting with suspected acute coronary syndrome in Singapore.

Ziwei Lin; Swee Han Lim; Siang Jin Terrance Chua; E Shyong Tai; Yiong Huak Chan; Arthur Mark Richards

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High-sensitivity troponin T and long-term adverse cardiac events among patients presenting with suspected acute coronary syndrome in Singapore.

Author: Ziwei LIN ¹ ; Swee Han LIM ² ; Siang Jin Terrance CHUA ³ ; E Shyong TAI ⁴ ; Yiong Huak CHAN ⁵ ; Arthur Mark RICHARDS ⁶
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1. Emergency Medicine Department, National University Hospital, National University Health System, Singapore.
2. Department of Emergency Medicine, Singapore General Hospital, Singapore.
3. Department of Cardiology, National Heart Centre Singapore, Singapore.
4. Division of Endocrinology, National University Hospital, National University Health System, Singapore.
5. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
6. Christchurch Heart Institute, Department of Medicine, University of Otago, New Zealand.
Publication Type:Journal Article
Keywords: acute coronary syndrome; chest pain; troponin
From:Singapore medical journal 2019;60(8):418-426
CountrySingapore
Language:English
Abstract: INTRODUCTION:Prognostic thresholds for 30-day major adverse cardiac events (MACE) have been studied for high-sensitivity troponin T (hsTnT) in patients with suspected acute coronary syndrome (ACS), but there is limited data on the prognostic performance of hsTnT for one-year MACE.
METHODS:We prospectively measured hsTnT (in ng/mL up to two decimal places) at 0, 2 and 7 hours for patients presenting with symptoms suggestive of ACS to our emergency department from March 2010 to April 2013. We assessed the prognostic performance of hsTnT cut-offs for 30-day and one-year MACE, and the utility of delta-hsTnT in predicting MACE.
RESULTS:Among 2,444 patients studied, 273 (11.2%) developed MACE (including index MACE) by 30 days and 359 (14.7%) patients developed MACE at one year. The suggested hsTnT cut-off for 30-day MACE was ≥ 10 ng/L at 0 hour (positive predictive value [PPV] 33.5%, negative predictive value [NPV] 94.5%) and 7 hours (PPV 37.3%, NPV 94.5%), and ≥ 20 ng/L at 2 hours (PPV 36.9%, NPV 96.9%). For one-year MACE, the suggested cut-off was also ≥ 10 ng/L at all readings. Plasma hsTnT ≥ 30 ng/L at any reading gave PPV > 54% and NPV > 93% for 30-day MACE. Absolute 0-2 hour and 2-7 hour delta-hsTnT ≥ 10 ng/L gave PPV > 50% for 30-day and one-year MACE.
CONCLUSION:Patients with 0-, 2- or 7-hour hsTnT ≥ 30 ng/L and 0-2 hour delta-hsTnT ≥ 10 ng/L had PPV > 50% for 30-day and one-year MACE, and should be investigated thoroughly.