Introduction: Whether high-sensitivity cardiac troponin T (hs-cTnT) levels provide valuable diagnostic and prognostic information across the spectrum of patients with acute coronary syndrome (ACS) is not known.
Methods: We included 411 unselected patients with chest pain in a Norwegian teaching hospital, and the physicians in the Emergency Department annotated the probability of ACS from 0-100%. Blood samples were collected during admission. The index diagnosis of ACS vs. non-cardiac chest pain was adjudicated by two physicians.
Results: One-hundred-sixty-eight patients (40%) were classified as hospitalized with ACS, including 88 patients with unstable angina pectoris. The receiver operating characteristics area under the curve (AUC) of hs-cTnT to diagnose ACS was 0.83 (95%CI 0.78-0.87), the AUC of physicians was 0.80 (0.76-0.85), and the combination of hs-cTnT levels and physician yielded an AUC of 0.88 (0.85-0.91). All-cause mortality during median 6.6 years follow-up was 50 patients in the ACS-population (30%) and 16 patients in the non-ACS-population (7%). hs-cTnT measurements levels in the total population separated patients with a favorable and a poor prognosis (Figure). Adjusting for demographics, comorbidities and clinical status, hs-cTnT levels were still associated with time to death: HR 1.34 (95%CI 1.19-1.52), p<0.001.
Conclusions: hs-cTnT measurements provide valuable diagnostic and prognostic information across the spectrum of ACS.