The Elevated High-Sensitivity Cardiac Troponin T Pilot: Diagnoses and Outcomes |
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| Affiliation: | 1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN;2. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN;3. Department of Hospital Internal Medicine, Mayo Clinic, Rochester, MN;1. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN;2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN;3. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN;1. Department of Internal Medicine, Mayo Clinic, Rochester, MN;2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN;3. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN;1. Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD;2. Department of Health, Physical Education, and Sport Studies, Winston-Salem State University, Winston-Salem, NC;3. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN;4. Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI;5. Houston Methodist DeBakey Heart & Vascular Center, Houston, TX;1. Division of Hematology, University of Washington, Seattle, Washington;2. Fred Hutchinson Cancer Research Center, Seattle, Washington;3. Department of Pathology, University of Washington, Seattle, Washington;1. Department of Medicine, University of California, Los Angeles, CA;2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN |
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| Abstract: | ![]()
ObjectiveTo identify the diagnoses and outcomes associated with elevated high sensitivity cardiac troponin T (hs-cTnT) compared with the 4th-generation troponin T and to validate the Mayo Clinic hs-cTnT myocardial infarction algorithm cutoff values.Patients and MethodsConsecutive blood samples of patients presenting to the emergency department between July 2017 and August 2017, who had 4th-generation troponin T, were also analyzed using the hs-cTnT assay. Troponin T values, discharge diagnoses, comorbidities, and outcomes were assessed. In addition, analyses of sex-specific and hs-cTnT cutoff values were assessed.ResultsOf 830 patients, 32% had an elevated 4th-generation troponin T, whereas 64% had elevated hs-cTnT. With serial sampling, 4th-generation troponin missed a chronic myocardial injury pattern and acute myocardial injury pattern in 64% and 16% of patients identified with hs-cTnT, respectively. Many of these “missed” patients had discharge diagnoses associated with cardiovascular disease, infection, or were postoperative. Five of the 6 patients with unstable angina ruled in for myocardial infarction.ConclusionThere were many increases in hs-cTnT that were missed by the 4th-generation cTnT assay. Most new increases are not related to acute cardiac causes. They were more consistent with chronic myocardial injury. High-sensitivity cTnT did reclassify most patients with unstable angina as having non–ST-elevation myocardial infarction. Older age, more comorbidities, and lower hemoglobin were associated with elevated hs-cTnT. Our data also support the use of our sex-specific cutoff values. |
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