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07. Syncope and Bradycardia
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32. Cardiovascular Nursing
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Performance of different high sensitivity cardiac troponin assays in patients with suspected acute coronary syndrome
Session:
Posters (Sessão 5 - Écran 6) - DAC e Cuidados Intensivos 7 - Marcadores de Risco e Prognóstico
Speaker:
Gustavo M. Campos
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.3 Acute Coronary Syndromes – Diagnostic Methods
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Gustavo m. Campos; Ana Vera Marinho; Luis Leite; André Azul; Cátia Ferreira; Sofia Martinho; José Paulo Almeida; João Rosa; Rita Gomes; Patricia Alves; Rui Batista; João Pego; Isabel Fonseca; Fernando Rodrigues; Francisco Gonçalves; Lino Gonçalves
Abstract
<p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Background: </strong>High-sensitivity cardiac troponin (hs-cTn) is increasingly used in the assessment of cardiovascular (CV) risk in the emergency department (ED). Although guidelines recommend the use of 99th centile as the diagnostic threshold for myocardial infarction (MI), there is less consensus on the optimal troponin threshold to rule-out patients with low risk of CV events with a single measurement. </span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Objectives:</strong> We aimed to compare prognostic accuracy of three high-sensitivity troponin assays in a large cohort of patients admitted in ED.</span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Methods: </strong>Prospective cohort study enrolling all consecutive patients admitted to the ED of a tertiary hospital with suspected MI. Triple testing included Abbott Architect hs Troponin, Roche Elecsys hsTroponin T and Siemens Dimension EXL Troponin. The predefined combined endpoint included MI, unscheduled coronary revascularization and CV mortality.</span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Results: </strong>A total of 548 patients (mean age of age 67±19 years) were included. During a mean follow-up of 34 ±10 months, the incidence of primary endpoint was 12.6%. With only one measurement, the Roche Elecsys assay had the highest accuracy (AUC: 0.84, 95% CI:0.75–0.93). The negative predictive values for undetectable values of troponin in Abbott Architect and Roche Elecsys assays were: 100.0% (95% CI: 90.0-100.0%) and 99.2 (95%CI: 97.2-100.0%), respectively. Using an optimized risk stratification threshold of 5 ng/L in Abbott Architect, compared with the limit of <2 ng/L, identifies twice more low risk patients.</span></span></p> <p><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Conclusion: </strong>Both hs-cTn assays have excellent accuracy in the evaluation of suspected ACS, but a higher threshold can optimize the selection of patients that can be safely discharged with a single measurement<strong>.</strong></span></span></p>
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