Prognostic Value of ultra-sensitive troponin-I in Acute Coronary Syndrome Patients in Emergency Department

Acute Coronary Syndromes (ACS) cause significant morbidity and mortality in our country and worldwide. With the advancement in technology early diagnosis and treatment is available. In the modern era, the most valuable diagnostic markers are cardiac troponins. It has been showed that the contemporary new generation high sensitivity troponin kits outperform conventional troponins both diagnostically and prognostically. In our study, we aimed to find the value of contemporary ultrasensitive cardiac troponin I on 30- day and 90-day mortality. Our study was done retrospectively by evaluating patient data between 11/07/2015-06/01/2016. All included patients were scanned in the national death index and deceased patients were recorded. 7,207 patients whom ultrasensitive troponin ordered were included in the study. The mean ages of the patients were 58±18.04 years and 55.7% were male. The area under the curve (AUC) for the 30 day mortality of the initial ultrasensitive troponin assay in the Emergency Department (ED) was 0,803 (95% CI: 0.793-0.813). The threshold value the ultrasensitive troponin in our hospital was 0,006 with sensitivity of 56,6% (95% CI: 49.8%-62.1%), and specificity of 89,3% (95% CI: 88.5%-90.0%). The threshold value for the 99% of the population was 0,004 with the sensitivity of 65.5% (95% CI: 59.5%-71.2%) and specificity of 84.4% (95% CI:83.5%-85.3%). AUC for the 90 day mortality of the initial ultrasensitive troponin assay in the ED was 0.763 (95% CI: 0.752-0.773). The sensitivity and specificity of the threshold value of the ultrasensitive troponin in our hospital for 90-day mortality were 46.2% (95% CI: 41.5%-50.9%) and 89.8% (95 CI: 89.1%-90.6%) respectively. The sensitivity and specificity of the threshold value of the ultrasensitive troponin for the 99% of the population were 57.4% (95% CI: 52.7%-62.1%) and 85.3% (95%: 84.4%-86.2%) respectively. 46 The initial value of ultrasensitive troponin value obtained in the ED does not have enough value to determine the 30-day and 90-day mortality. However, troponin values within normal range and trending down of the troponin values increase the sensitivity in excluding mortality. Key words: Ultrasensitive troponin, chest pain, prognosis, emergency department