Prognostic performance of kinetic changes of high-sensitivity troponin T in acute coronary syndrome and in patients with increased troponin without acute coronary syndrome

•We assessed prognostic performance of hs-cTnT kinetic changes in ACS and non-ACS.•We highlight new aspects concerning hs assays and the incremental clinical value.•Magnitude of hs-cTnT elevation was superior to kinetic changes for risk assessment.•Incremental clinical value of kinetic hs-cTnT changes for prognostication was low.•Elevated hs-cTnT was associated with adverse outcomes regardless ACS or non-ACS.

BackgroundWe sought to evaluate the prognostic impact of absolute and relative kinetic changes of high-sensitivity cardiac Troponin T (hs-cTnT) in comparison to baseline hs-cTnT elevations for risk stratification in acute coronary syndrome (ACS) and non-ACS conditions with increased hs-cTnT.Methodshs-cTnT was measured serially in patients presenting with acute symptoms to our emergency department. We assessed the prognostic performance of baseline and serial hs-cTnT concentrations in all consecutive patients with ACS (n = 406) or hs-cTnT increases not due to ACS (n = 442) within 3-6 h after admission.ResultsMortality rates were higher, albeit not statistically, in non-ACS (53/442 = 12.0%) than ACS patients (36/406 = 8.9%). In ACS patients, receiver operating characteristics (ROC) revealed optimized cut-off values of 12.2 ng/L for absolute δ-change (AUC = 0.66, p < 0.001), 31.2 ng/L for baseline hs-cTnT (AUC = 0.71, p < 0.001) and 45.2 ng/L for maximal hs-cTnT (AUC = 0.68, p < 0.001). C-statistics showed superiority of absolute δ-changes (p = 0.0003), baseline hs-cTnT (p = 0.04) and maximal hs-cTnT (p = 0.02) compared to relative δ-changes. However, the combination of baseline hs-cTnT values with either absolute or relative δ-changes did not improve risk prediction compared to baseline hs-cTnT alone (p = n.s.). In non-ACS conditions, the ROC-optimized cut-off value of 46.2 ng/L for baseline hs-cTnT (AUC = 0.661, p < 0.001) was superior to absolute (p = 0.007) and relative δ-changes regarding prognostication (p = 0.045).ConclusionsOur data suggest that the magnitude of baseline hs-cTnT, and not acute dynamic changes, convey superior long-term prognostic information in ACS and non-ACS conditions. Moreover, absolute and relative kinetic δ-changes of hs-cTnT do not add significant incremental value in risk assessment in both conditions.