Improved diagnostic and prognostic performance of a new high-sensitive troponin T assay in patients with acute coronary syndrome.

BACKGROUND: In the present study, we aimed to analyze the diagnostic and prognostic potential of a newly developed high-sensitive troponin T assay and compared these results with those of a contemporary troponin T assay in 2 distinct patient cohorts, one including patients with evident ACS and the other one including patients with general chest pain. METHODS AND RESULTS: For this study, we analyzed data from 2 independent patient cohorts, the Bad Nauheim ACS registry and the Prognosis in Acute Coronary Syndromes registry, with a total of 2,506 patients. On admission, clinical data have been recorded, and a single measurement of troponin T has been performed with a contemporary assay (TnT) and a new high-sensitive troponin T assay (hsTnT). Clinical follow-up has been obtained after 6 months. The diagnostic value of hsTnT was superior to TnT (area under the receiver operating characteristic curve 0.949 vs 0.929, P = .016). Specifically, in TnT-negative patients, hsTnT provided strong diagnostic information (area under the receiver operating characteristic curve of 0.81, P < .001). Furthermore, hsTnT provided independent prognostic power for mortality within 6 months in both cohorts, which was superior to that of the contemporary TnT assay. CONCLUSION: Troponin T measured with a newly developed hsTnT provides better diagnostic and prognostic information and, therefore, should be implemented as a standard test in clinical routine.

Direct admission versus transfer of AMI patients for primary PCI.

BACKGROUND: Guidelines for the treatment of patients with ST-elevation myocardial infarction (STEMI) recommend primary PCI as first choice therapy. This recommendation has been linked to defined time limits achievable in a logistic network for the treatment of ACS. In the present study we analyzed the difference in 6 months outcome between STEMI patients who were admitted directly to a PCI center and those requiring transfer for primary PCI. RESULTS: 2,034 consecutive patients were included in the Bad Nauheim ACS registry. Admission diagnosis was STEMI in 1,057 (52%) patients (71% male, aged 63 ± 13). 637 (60%) patients were directly admitted for primary PCI with a time delay from first medical contact until admission in the PCI center of 64 min (IQR 45-90) at median and door-to-balloon time (DTB) at median 29 min (IQR 20-41). 420 (40%) patients were transferred from peripheral hospitals. In this subgroup time delay was 135 min (IQR 69-285) and DTB at median 31 min (IQR 22-49). 178 (16.8%) patients were at high risk (CPR or cardiogenic shock). Patients, who were admitted directly had a better outcome as transferral patients (log rank 6.1; p = 0.013 for 6 months mortality). However, Kaplan-Meier survival analysis (log rank 4.25; p = 0.039) and Cox regression analysis (95% CI 1.08-3.17; p = 0.026) revealed that this difference in outcome was restricted to high-risk patients. CONCLUSION: A network for the treatment of STEMI provides the logistic basis for the initiation of primary PCI according to current guidelines. However, transferral patients do not meet the defined time limits. Mortality rates for high-risk transferral patients appear to be higher as those of patients taken directly to the center by the EMS.