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Valor prognóstico da troponina I de alta sensibilidade versus troponina T nas síndromes coronarianas agudas

2012; Sociedade Brasileira de Cardiologia (SBC); Volume: 98; Issue: 5 Linguagem: Inglês

10.1590/s0066-782x2012005000034

1678-4170

Luís Cláudio Lemos Correia, Fábio L. Sodré, José C.C. Lima, Michael Sabino, Mariana Brito, Guilherme J. M. Garcia, Mayara Maraux, Alexandre C. Sousa, Márcia Noya Rabelo, J. Péricles Esteves,

Venous Thromboembolism Diagnosis and Management

Background: Despite superior diagnostic accuracy of high-sensitivity cardiac troponins, their prognostic value has not been validated against conventional cardiac troponins.Objective: To test the prognostic value of high-sensitivity cardiac troponin I (hs-cTnI), compared with conventional cardiac troponin T (cTnT) in the setting of non-ST elevation acute coronary syndromes.Methods: At hospital admission, a plasma sample was collected from 103 consecutive patients with unstable angina or non-ST elevation acute myocardial infarction.In this sample, troponin was measured both by hs-cTnI and cTnT methods.Their prognostic value was compared as to the occurrence of major cardiovascular events, defined as a combination of death, nonfatal acute myocardial infarction or refractory unstable angina during hospitalization.Results: During median hospitalization of 8 days (interquartile range = 5 -11), the incidence of cardiovascular events was 10% (5 deaths, 3 non-fatal myocardial infarctions and 2 non-fatal refractory anginas).High-sensitivity troponin I significantly predicted cardiovascular events, with a C-statistics of 0.73 (95% CI = 0.59 -0.87), similarly to cTnT (0.70; 95% CI = 0.55 -0.84) -P = 0.75.The definition of positive cardiac marker that provided the best prognostic accuracy was hs-cTnI > 0.055 µg/L and cTnT > 0.010 µg/L, with equal sensitivity of 90% and specificity of 52% for both assays.Positive hs-cTnI was associated with 17% incidence of events, compared with 2% in patients with negative hs-cTnI (P = 0.02).Conclusion: High-sensitivity troponin I predicts cardiovascular events similarly to conventional troponin T in the setting of non-ST-elevation ACS.(Arq Bras Cardiol 2012;98(5):406-412) Keywords: Acute coronary syndrome; troponin; prognosis.never been compared with the prognostic value of current conventional troponins in acute coronary syndromes.In order to evaluate whether high-sensitivity troponin I (hs-cTnI) offers a similar or superior prognostic value compared to conventional troponin T (cTnT) in patients with non-ST elevation acute coronary syndromes, we measured troponin by both assays at admission of 103 patients and cardiovascular events were recorded during hospitalization. Methods Study PopulationConsecutive patients admitted to our coronary care unit due to unstable angina pectoris or non-ST elevation acute myocardial infarction between August 2008 and September 2009 were considered candidates for the study.Inclusion criteria were defined as onset of typical chest discomfort for at least 5 minutes, in the first 48 hours, absence of ST-segment elevation and at least one of the following objective criteria: (1) positive troponin in any of the three serial measurements performed on the first day of hospitalization, defined as cTnT > 0.030 µg/L, which corresponds to the value above the 99 th percentile which is a healthy reference population and total imprecision of 10%