OBJECTIVE: The frequency and implications of an elevated cardiac troponin (4th or 5th 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 4th generation TnT drawn had the 5th 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 5th generation TnT while 46% had elevated 4th generation TnT. 5th generation TnT was more sensitive and less specific than 4th generation TnT in predicting both ACM and MACE. The sensitivities for the 5th generation TnT assay were 85% for ACM and 90% for MACE rates, compared to 65% and 70% respectively for the 4th generation assay. 5th generation TnT positive patients that were missed by 4th 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 5th generation TnT assay.
CONCLUSIONS: In patients admitted for a non-cardiac condition, 5th generation TnT is more sensitive although less specific in predicting MACE and ACM. 5th generation TnT identifies an intermediate risk group for ACM previously missed with the 4th generation assay.
Digital Object Identifier (DOI)
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.
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., "5th Generation vs 4th 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.
S1 Fig. Patient selection flow chart (STROBE Diagram). https://doi.org/10.1371/journal.pone.0246332.s001
journal.pone.0246332.s002.tif (933 kB)
S2 Fig. Correlation at lower levels between the 4th generation Troponin T assay and the 5th generation Troponin T assay on the same blood samples. https://doi.org/10.1371/journal.pone.0246332.s002
journal.pone.0246332.s003.tif (723 kB)
S3 Fig. All-Cause Mortality (ACM) and MACE rates based on reason for admission. https://doi.org/10.1371/journal.pone.0246332.s003
journal.pone.0246332.s004.docx (27 kB)
S1 Table. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 4th and 5th generation troponin T in predicting all-cause mortality. https://doi.org/10.1371/journal.pone.0246332.s004
journal.pone.0246332.s005.docx (27 kB)
S2 Table. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 4th and 5th generation troponin T in predicting MACE. https://doi.org/10.1371/journal.pone.0246332.s005
journal.pone.0246332.s006.xlsx (225 kB)
S1 Dataset. https://doi.org/10.1371/journal.pone.0246332.s006