5^th Generation vs 4^th Generation Troponin T in Predicting Major Adverse Cardiovascular Events and All-Cause Mortality in Patients Hospitalized for Non-Cardiac Indications: A Cohort Study

Authors

Vedant Gupta, University of KentuckyFollow
Marc Paranzino, University of KentuckyFollow
Talal Alnabelsi, University of Kentucky
Karam Ayoub, University of KentuckyFollow
Joshua Eason, University of KentuckyFollow
Andin Mullis, University of Kentucky
John R. Kotter, University of KentuckyFollow
Andrew Parks, University of KentuckyFollow
Levi May, University of Kentucky
Sethabhisha Nerusu, University of KentuckyFollow
Chen Dai, University of Kentucky
Daniel Cleland, University of KentuckyFollow
Steve W. Leung, University of KentuckyFollow
Vincent L. Sorrell, University of KentuckyFollow

Abstract

OBJECTIVE: The frequency and implications of an elevated cardiac troponin (4^th or 5^th generation TnT) in patients outside of the emergency department or presenting with non-cardiac conditions is unclear.

METHODS: Consecutive patients aged 18 years or older admitted for a primary non-cardiac condition who had the 4^th generation TnT drawn had the 5^th generation TnT run on the residual blood sample. Primary and secondary outcomes were all-cause mortality (ACM) and major adverse cardiovascular events (MACE) respectively at 1 year.

RESULTS: 918 patients were included (mean age 59.8 years, 55% male) in the cohort. 69% had elevated 5^th generation TnT while 46% had elevated 4^th generation TnT. 5^th generation TnT was more sensitive and less specific than 4^th generation TnT in predicting both ACM and MACE. The sensitivities for the 5^th generation TnT assay were 85% for ACM and 90% for MACE rates, compared to 65% and 70% respectively for the 4^th generation assay. 5^th generation TnT positive patients that were missed by 4^th generation TnT had a higher risk of ACM (27.5%) than patients with both assays negative (27.5% vs 11.1%, p< 0.001), but lower than patients who had both assay positive (42.1%). MACE rates were not better stratified using the 5^th generation TnT assay.

CONCLUSIONS: In patients admitted for a non-cardiac condition, 5^th generation TnT is more sensitive although less specific in predicting MACE and ACM. 5^th generation TnT identifies an intermediate risk group for ACM previously missed with the 4^th generation assay.

Document Type

Article

Publication Date

2-9-2021

Notes/Citation Information

Published in PLOS ONE, v. 16, issue 2, e0246332.

© 2021 Gupta et al.

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Digital Object Identifier (DOI)

https://doi.org/10.1371/journal.pone.0246332

Funding Information

The project described was supported by the University of Kentucky Center for Health Services Research Data, Analytics, and Statistical Core. Roche Diagnostics provided the reagents for the 5th generation Troponin T free of cost.

Repository Citation

Gupta, Vedant; Paranzino, Marc; Alnabelsi, Talal; Ayoub, Karam; Eason, Joshua; Mullis, Andin; Kotter, John R.; Parks, Andrew; May, Levi; Nerusu, Sethabhisha; Dai, Chen; Cleland, Daniel; Leung, Steve W.; and Sorrell, Vincent L., "5^th Generation vs 4^th Generation Troponin T in Predicting Major Adverse Cardiovascular Events and All-Cause Mortality in Patients Hospitalized for Non-Cardiac Indications: A Cohort Study" (2021). Gill Heart & Vascular Institute Faculty Publications. 24.
https://uknowledge.uky.edu/heart_facpub/24