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Prognostic value of a single cTn measurement vs absolute change in different patterns of myocardial injury: when one is better than two
Session:
Posters 5 - Écran 01 - Isquemia/SCA
Speaker:
Mariana Gonçalves
Congress:
CPC 2018
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Mariana Gonçalves; Cláudia Jesus Silva; António Tralhão; Catarina Brízido; Francisco Fernandes Gama; Gustavo Mendes; Afonso Félix De Oliveira; Sara Guerreiro; Jorge Santos Ferreira; Miguel Mendes; João Carmo
Abstract
<p><strong>Background and aim: </strong>cTn release from myocardial injury improves risk stratification in a wide range of acute illness. The diagnostic value of delta troponin is already well stablished. However, whether absolute or relative changes differ over single value assessments remains to be fully elucidated. We sought to compare the added prognostic impact of different cTn-related metrics according to type of myocardial infarction, using age and B-type NT-terminal natriuretic peptide as a baseline model.</p> <p> </p> <p><strong>Methods: </strong>retrospective analysis of consecutive patients admitted in the emergency room of a tertiary hospital for any acute illness in a 5-month period (March - July 2016) with two available serial cardiac troponin T (high-sensitivity 4<sup>th</sup> generation assay) measurements according to a 3h protocol (0h [Tn0] and 0-3h variation [deltaTn]). Final adjudicated diagnosis according to international classification of diseases 9<sup>th</sup> version was categorized as acute coronary syndrome (including type 1 MI and type 2 according to the 3<sup>rd</sup> universal definition of myocardial infarction), non-ischemic cardiac causes or non-cardiac myocardial injury. Primary endpoint was defined as a composite of mortality, MI or stroke (MACCE).</p> <p> </p> <p><strong>Results: </strong>a population of 1046 patients was obtained (mean age 77 ± 13 years, 71% male). The main referred symptoms were: chest pain in 38% (n = 402), followed by dyspnea in 31% (n = 326) and syncope in 18% (n = 186). Final diagnosis was acute coronary syndrome in 12% (n = 124), myocardial injury from a non-coronary cardiac cause 31% (n = 323) and non-cardiac myocardial injury in 55% (n = 573). In a median follow-up of 1.03 (IQR-0.68-1.21) years, the primary endpoint occurred in 30% of patients (n = 310). When added individually to a Cox regression multivariate model based on age and NT-pro-BNP, both Tn0 and deltaTn were independently associated with increased MACCE [HR 1.003 (CI95% 1.001-1.004), p = 0.001]; HR 1.031 (CI 95% 1.011-1.051, p = 0.002]. However, ROC curve analysis using survival function showed superior risk prediction when Tn0 was entered into the model instead of deltaTn [C-statistic 0.715 (CI 95% 0.618-0.812) vs. 0.667 (CI 95% 0.561-0.772), p < 0.05]. Elevated Tn0 significantly imparted a worse prognosis in coronary MI (including type 1 and 2) when compared to the remainder MI injury causes (42% vs. 30% MACCE, p = 0.037)</p> <p> </p> <p><strong>Conclusions: </strong>when added to a simple model containing two commonly used variables, admission high-sensitivity cTnT outperformed deltaTn in MACCE prediction in acutely ill patients, among who type 2 myocardial infaction seems to be prevalent. Elevated admission cTnT seems to confer a worse prognosis in type 2 myocardial infarction compared to other types of myocardial injury.</p>
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