Diagnosing Myocardial Injury in an Acute Chest Pain Cohort; Long-Term Prognostic Implications of Cardiac Troponin T and I.

IF 7.1 2区医学 Q1 MEDICAL LABORATORY TECHNOLOGY

Clinical chemistry Pub Date : 2024-10-03 DOI:10.1093/clinchem/hvae110

Nasir Saeed, Ole-Thomas Steiro, Jørund Langørgen, Hilde L Tjora, Rune O Bjørneklett, Øyvind Skadberg, Vernon V S Bonarjee, Øistein R Mjelva, Tone M Norekvål, Trude Steinsvik, Kjell Vikenes, Torbjørn Omland, Kristin M Aakre

{"title":"Diagnosing Myocardial Injury in an Acute Chest Pain Cohort; Long-Term Prognostic Implications of Cardiac Troponin T and I.","authors":"Nasir Saeed, Ole-Thomas Steiro, Jørund Langørgen, Hilde L Tjora, Rune O Bjørneklett, Øyvind Skadberg, Vernon V S Bonarjee, Øistein R Mjelva, Tone M Norekvål, Trude Steinsvik, Kjell Vikenes, Torbjørn Omland, Kristin M Aakre","doi":"10.1093/clinchem/hvae110","DOIUrl":null,"url":null,"abstract":"Background: There are limited data regarding the utility of follow-up cardiac troponin (cTn) measurements after admission for acute chest pain and how long-term stability of myocardial injury and prognostic value differ when using cardiac troponin T (cTnT) or I (cTnI).Methods: We measured high-sensitivity (hs)-cTnT (Roche Diagnostics) and hs-cTnI (Siemens Healthineers) during hospitalization for acute chest pain and after 3 months. Acute myocardial injury was defined as concentrations > sex-specific upper reference limit (URL) during hospitalization and ≤URL at 3-months. Chronic myocardial injury (CMI) was defined as concentrations > URL at both time points. Patients were followed from the 3-month sampling point for a median of 1586 (IQR 1161-1786) days for a primary composite endpoint of all-cause mortality, myocardial infarction (MI), revascularization, and heart failure, and a secondary endpoint of all-cause mortality.Results: Among 754 patients, 33.8% (hs-cTnT) and 19.2% (hs-cTnI) had myocardial injury during hospitalization. The rate of CMI was 5 times higher by hs-cTnT (20%) assay than hs-cTnI (4%), while acute myocardial injury was equally common; 14% (hs-cTnT) and 15% (hs-cTnI), respectively (6% and 5% when excluding index non-ST-elevation MI (NSTEMI). For hs-cTnT, peak index concentration, 3-month concentration and classification of CMI predicted the primary endpoint; hazard ratios (HRs) 1.38 (95% CI 1.20-1.58), 2.34 (1.70-3.20), and 2.31 (1.30-4.12), respectively. For hs-cTnI, peak index concentration predicted the primary endpoint; HR 1.14 (1.03-1.25). This association was nonsignificant after excluding index NSTEMI.Conclusions: Acute myocardial injury is equally frequent, whereas CMI is more prevalent using hs-cTnT assay than hs-cTnI. Measuring hs-cTnT 3 months after an acute chest pain episode could assist in further long-term risk assessment. ClinicalTrials.gov Registration Number: NCT02620202.","PeriodicalId":10690,"journal":{"name":"Clinical chemistry","volume":" ","pages":"1241-1255"},"PeriodicalIF":7.1000,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical chemistry","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/clinchem/hvae110","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICAL LABORATORY TECHNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: There are limited data regarding the utility of follow-up cardiac troponin (cTn) measurements after admission for acute chest pain and how long-term stability of myocardial injury and prognostic value differ when using cardiac troponin T (cTnT) or I (cTnI).

Methods: We measured high-sensitivity (hs)-cTnT (Roche Diagnostics) and hs-cTnI (Siemens Healthineers) during hospitalization for acute chest pain and after 3 months. Acute myocardial injury was defined as concentrations > sex-specific upper reference limit (URL) during hospitalization and ≤URL at 3-months. Chronic myocardial injury (CMI) was defined as concentrations > URL at both time points. Patients were followed from the 3-month sampling point for a median of 1586 (IQR 1161-1786) days for a primary composite endpoint of all-cause mortality, myocardial infarction (MI), revascularization, and heart failure, and a secondary endpoint of all-cause mortality.

Results: Among 754 patients, 33.8% (hs-cTnT) and 19.2% (hs-cTnI) had myocardial injury during hospitalization. The rate of CMI was 5 times higher by hs-cTnT (20%) assay than hs-cTnI (4%), while acute myocardial injury was equally common; 14% (hs-cTnT) and 15% (hs-cTnI), respectively (6% and 5% when excluding index non-ST-elevation MI (NSTEMI). For hs-cTnT, peak index concentration, 3-month concentration and classification of CMI predicted the primary endpoint; hazard ratios (HRs) 1.38 (95% CI 1.20-1.58), 2.34 (1.70-3.20), and 2.31 (1.30-4.12), respectively. For hs-cTnI, peak index concentration predicted the primary endpoint; HR 1.14 (1.03-1.25). This association was nonsignificant after excluding index NSTEMI.

Conclusions: Acute myocardial injury is equally frequent, whereas CMI is more prevalent using hs-cTnT assay than hs-cTnI. Measuring hs-cTnT 3 months after an acute chest pain episode could assist in further long-term risk assessment. ClinicalTrials.gov Registration Number: NCT02620202.

查看原文本刊更多论文

诊断急性胸痛队列中的心肌损伤；心肌肌钙蛋白 T 和 I 的长期预后意义。

背景：关于急性胸痛入院后随访心肌肌钙蛋白（cTn）测量的效用，以及使用心肌肌钙蛋白 T（cTnT）或 I（cTnI）时心肌损伤的长期稳定性和预后价值有何不同，相关数据十分有限：我们在急性胸痛住院期间和 3 个月后测量了高敏 (hs)-cTnT （罗氏诊断公司）和 hs-cTnI（西门子健康公司）。急性心肌损伤的定义是：住院期间浓度>特定性别参考上限 (URL)，且 3 个月后≤URL。慢性心肌损伤（CMI）的定义是两个时间点的浓度均大于 URL。从3个月的取样点开始，对患者进行了中位数为1586天（IQR 1161-1786）的随访，以确定全因死亡率、心肌梗死（MI）、血管重建和心力衰竭的主要复合终点以及全因死亡率的次要终点：在 754 名患者中，33.8%（hs-cTnT）和 19.2%（hs-cTnI）在住院期间出现心肌损伤。hs-cTnT（20%）检测的CMI率是hs-cTnI（4%）的5倍，而急性心肌损伤同样常见；分别为14%（hs-cTnT）和15%（hs-cTnI）（如果不包括指数非ST段抬高型心肌梗死（NSTEMI），则分别为6%和5%）。对于 hs-cTnT，指数峰值浓度、3 个月浓度和 CMI 分类可预测主要终点；危险比 (HR) 分别为 1.38（95% CI 1.20-1.58）、2.34（1.70-3.20）和 2.31（1.30-4.12）。对于 hs-cTnI，峰值指数浓度可预测主要终点；HR 为 1.14（1.03-1.25）。排除指数NSTEMI后，这一关联并不显著：急性心肌损伤的发生率相同，但使用 hs-cTnT 检测的 CMI 比 hs-cTnI 更常见。在急性胸痛发作 3 个月后测量 hs-cTnT，有助于进一步进行长期风险评估。ClinicalTrials.gov 注册号：NCT02620202：NCT02620202。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical chemistry 医学-医学实验技术

CiteScore

11.30

自引率

4.30%

发文量

212

审稿时长

1.7 months

期刊介绍： Clinical Chemistry is a peer-reviewed scientific journal that is the premier publication for the science and practice of clinical laboratory medicine. It was established in 1955 and is associated with the Association for Diagnostics & Laboratory Medicine (ADLM). The journal focuses on laboratory diagnosis and management of patients, and has expanded to include other clinical laboratory disciplines such as genomics, hematology, microbiology, and toxicology. It also publishes articles relevant to clinical specialties including cardiology, endocrinology, gastroenterology, genetics, immunology, infectious diseases, maternal-fetal medicine, neurology, nutrition, oncology, and pediatrics. In addition to original research, editorials, and reviews, Clinical Chemistry features recurring sections such as clinical case studies, perspectives, podcasts, and Q&A articles. It has the highest impact factor among journals of clinical chemistry, laboratory medicine, pathology, analytical chemistry, transfusion medicine, and clinical microbiology. The journal is indexed in databases such as MEDLINE and Web of Science.