Sensitive troponin assays and N-terminal pro-B-type natriuretic peptide in acute coronary syndrome: prediction of significant coronary lesions and long-term prognosis

Jørgen Gravning, Marit Kristine Smedsrud, Torbjørn Omland, Christian Eek, Helge Skulstad, Lars Aaberge, Bjørn Bendz, John Kjekshus, Lars Mørkrid, Thor Edvardsen
American Heart Journal 2013, 165 (5): 716-24

BACKGROUND: Sensitive troponin assays have substantially improved early diagnosis of myocardial infarction. However, the role of sensitive cardiac troponin (cTn) assays in prediction of significant coronary lesions and long-term prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS) remains unresolved.

METHODS: This prospective study includes 458 consecutive patients with NSTE-ACS admitted for coronary angiography. Serum levels of 4 commercial available sensitive troponin assays were analyzed (Roche high-sensitive cTnT [hs-cTnT; Roche Diagnostics, Basel, Switzerland], Siemens cTnI Ultra [Siemens, Munich, Germany], Abbott-Architect cTnI [Abbott, Abbott Park, IL], Access Accu-cTnI [Beckman Coulter, Nyon, Switzerland]), as well as a standard assay (Roche cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), before coronary angiography.

RESULTS: The relationship between the analyzed biomarkers and significant coronary lesions on coronary angiography, as quantified by area under the receiver operating characteristic curve, was significantly higher with Roche hs-cTnT, Siemens cTnI Ultra, and Access Accu-cTnI as compared with standard troponin T assay (P < .001 for all comparisons). This difference was mainly caused by increased sensitivity below the 99th percentile. Also, NT-proBNP was associated with the presence of significant coronary lesions. Cardiac troponin values were correlated with cardiac death (primary end point) during 1373 (1257-1478) days of follow-up. In both univariate and multivariate Cox regression analyses, NT-proBNP was superior to both hs-cTnT and cTnI in prediction of cardiovascular mortality. Troponin values with all assays were correlated with the need for repeated revascularization (secondary end point) during follow-up.

CONCLUSIONS: Sensitive cTn assays are superior to standard cTnT assay in prediction of significant coronary lesions in patients with NSTE-ACS. However, this improvement is primary caused by increased sensitivity below the 99th percentile. N-terminal pro-B-type natriuretic peptide is superior to cTns in prediction of long-term mortality.

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