Background: Previous studies indicate that the introduction of high-sensitivity troponin T (HsTnT) as a diagnostic tool for chest pain patients in the emergency department (ED) creates a high rate of false-positive tests. In the present study, we aimed to evaluate if the diagnostic performance of HsTnT for acute coronary syndrome (ACS) up to 3-4h after presentation in elderly patients can be improved. Methods: A total of 477 consecutive patients ≥ 75years, admitted to in-hospital care for chest pain suspicious of ACS, were retrospectively included. HsTnT values at presentation (0h) and at 3-4h were analysed. Receiver operating characteristic (ROC) curves were created for absolute and relative changes from 0 to 3-4h. ACS, non-elective percutaneous coronary intervention, coronary artery bypass grafting and death of all causes were recorded for all patients during a follow-up of 60days. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were analysed for different HsTnT cut-off values at 0 and 3-4h and for the combination of a HsTnT at presentation and an absolute change from 0 to 3-4h. Results: Twenty-seven percent of the patients had ACS and 21% acute myocardial infarction (AMI) during the hospital stay. The standard cut-off 14ng/L gave sensitivity and NPV for ACS of 88 and 90% at 3-4h. Specificity and PPV was 38 and 32% respectively. Analysing for non-ST elevation myocardial infarction (NSTEMI) alone gave a sensitivity and NPV of 100% but did not improve specificity and PPV. The area under the ROC-curve was larger for absolute than relative HsTnT changes from 0 to 3-4h. A combination of HsTnT at presentation > 30ng/L and/or a change > 5ng/L up to 3-4h gave a 63% specificity and a PPV of 46%, a 99% sensitivity and a NPV of 99% for NSTEMI. Conclusion: Our study indicates that HsTnT can neither exclude nor confirm ACS within 3-4h from presentation in patients ≥ 75years. NSTEMI can be excluded with HsTnT within 3-4h, but HsTnT cannot be used to rule in NSTEMI during the first 3-4h, not even by using a combination of the initial HsTnT result and the change from 0 to 3-4h. With combined criteria, the majority of the positive tests were still false positive. Our results indicate that in patients > 75years, HsTnT should be used primarily as an early rule-out tool for AMI.
CITATION STYLE
Borna, C., Frostred, K. L., & Ekelund, U. (2016). Predictive role of high sensitivity troponin T within four hours from presentation of acute coronary syndrome in elderly patients. BMC Emergency Medicine, 16(1). https://doi.org/10.1186/s12873-015-0064-z
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