TY - JOUR
T1 - Do High-sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?
AU - Clark, Carol L.
AU - Gibson, Thomas A.
AU - Weiss, Robert E.
AU - Yagapen, Annick N.
AU - Malveau, Susan E.
AU - Adler, David H.
AU - Bastani, Aveh
AU - Baugh, Christopher W.
AU - Caterino, Jeffrey M.
AU - Diercks, Deborah B.
AU - Hollander, Judd E.
AU - Nicks, Bret A.
AU - Nishijima, Daniel K.
AU - Shah, Manish N.
AU - Stiffler, Kirk A.
AU - Storrow, Alan B.
AU - Wilber, Scott T.
AU - Sun, Benjamin C.
N1 - Funding Information:
Received October 18, 2018; revision received January 26, 2019; accepted January 28, 2019. This work was presented at the American College of Emergency Physicians Scientific Assembly, San Diego, CA, October 2018. Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award R01HL111033. Clinical Trial Registration: NCT01802398, https://clinicaltrials.gov/ct2/show/NCT01802398?term=NCT+01802398&rank=1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Roche Diagnostics donated high-sensitivity troponin-T assays and NT-proBNP assays. Roche had no role in data analysis or manuscript preparation. CLC’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. CLC’s institution has received contract funding from Radiometer and Ortho Scientific for industry-initiated research. TAG’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. REW’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. ANY’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. SEM’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. DHA’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health institution and has received contract funding for industry-initiated research from Roche. AB’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. AB’s institution has received contract funding from Radiometer and Ortho Scientific for industry-initiated research. CWB’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. CWB has received funding personally from Roche for consulting. JMC institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. DBD’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. DBD has received funding personally from Roche for consulting and DBD’s institution has received contract funding from Novartis, Ortho Scientific, and Roche for industry-initiated research institutional research. JEH’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health and JEH’s institution has received contract funding from Alere, Siemens, Roche, and Trinity for industry-initiated research institutional research. DKN’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. DKN has received funding personally from Roche for consulting. MNS’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. KAS’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. ABS’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. ABS has received funding personally from Siemens and Quidel for consulting. STW’s institution has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. BCS has received grant funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health. BCS has received funding personally from Medtronic for consulting and received diagnostic testing platforms for this study from Roche. The authors have no potential conflicts to disclose. Author contributions: CLC is the responsible corresponding author; CLC, BCN, TAG, and REW had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis; CLC,TAG, REW, ANY, SEV, DHA, AB, CWB, JMC, DBD, JEH, BAN, DKN, MNS, KAS, ABS, STW, and BCS had substantial contribution to the manuscript including responsibility for concept, data collection, manuscript development, review, and final approval. Supervising Editor: Brian C. Hiestand, MD. Address for correspondence and reprints: Carol L Clark, MD, MBA, FACEP; e-mail: carol.clark@beaumont.edu. ACADEMIC EMERGENCY MEDICINE 2019;26:528–538.
Publisher Copyright:
© 2019 by the Society for Academic Emergency Medicine
PY - 2019/5
Y1 - 2019/5
N2 - Objectives: An estimated 1.2 million annual emergency department (ED) visits for syncope/near syncope occur in the United States. Cardiac biomarkers are frequently obtained during the ED evaluation, but the prognostic value of index high-sensitivity troponin (hscTnT) and natriuretic peptide (NT-proBNP) are unclear. The objective of this study was to determine if hscTnT and NT-proBNP drawn in the ED are independently associated with 30-day death/serious cardiac outcomes in adult patients presenting with syncope. Methods: A prespecified secondary analysis of a prospective, observational trial enrolling participants ≥ age 60 presenting with syncope, at 11 United States hospitals, was conducted between April 2013 and September 2016. Exclusions included seizure, stroke, transient ischemic attack, trauma, intoxication, hypoglycemia, persistent confusion, mechanical/electrical invention, prior enrollment, or predicted poor follow-up. Within 3 hours of consent, hscTnT and NT-proBNP were collected and later analyzed centrally using Roche Elecsys Gen 5 STAT and 2010 Cobas, respectively. Primary outcome was combined 30-day all-cause mortality and serious cardiac events. Adjusting for illness severity, using multivariate logistic regression analysis, variations between primary outcome and biomarkers were estimated, adjusting absolute risk associated with ranges of biomarkers using Bayesian Markov Chain Monte Carlo methods. Results: The cohort included 3,392 patients; 367 (10.8%) experienced the primary outcome. Adjusted absolute risk for the primary outcome increased with hscTnT and NT-proBNP levels. HscTnT levels ≤ 5 ng/L were associated with a 4% (95% confidence interval [CI] = 3%–5%) outcome risk, and hscTnT > 50 ng/L, a 29% (95% CI = 26%–33%) risk. NT-proBNP levels ≤ 125 ng/L were associated with a 4% (95% CI = 4%–5%) risk, and NT-proBNP > 2,000 ng/L a 29% (95% CI = 25%–32%) risk. Likelihood ratios and predictive values demonstrated similar results. Sensitivity analyses excluding ED index serious outcomes demonstrated similar findings. Conclusions: hscTnT and NT-proBNP are independent predictors of 30-day death and serious outcomes in older ED patients presenting with syncope.
AB - Objectives: An estimated 1.2 million annual emergency department (ED) visits for syncope/near syncope occur in the United States. Cardiac biomarkers are frequently obtained during the ED evaluation, but the prognostic value of index high-sensitivity troponin (hscTnT) and natriuretic peptide (NT-proBNP) are unclear. The objective of this study was to determine if hscTnT and NT-proBNP drawn in the ED are independently associated with 30-day death/serious cardiac outcomes in adult patients presenting with syncope. Methods: A prespecified secondary analysis of a prospective, observational trial enrolling participants ≥ age 60 presenting with syncope, at 11 United States hospitals, was conducted between April 2013 and September 2016. Exclusions included seizure, stroke, transient ischemic attack, trauma, intoxication, hypoglycemia, persistent confusion, mechanical/electrical invention, prior enrollment, or predicted poor follow-up. Within 3 hours of consent, hscTnT and NT-proBNP were collected and later analyzed centrally using Roche Elecsys Gen 5 STAT and 2010 Cobas, respectively. Primary outcome was combined 30-day all-cause mortality and serious cardiac events. Adjusting for illness severity, using multivariate logistic regression analysis, variations between primary outcome and biomarkers were estimated, adjusting absolute risk associated with ranges of biomarkers using Bayesian Markov Chain Monte Carlo methods. Results: The cohort included 3,392 patients; 367 (10.8%) experienced the primary outcome. Adjusted absolute risk for the primary outcome increased with hscTnT and NT-proBNP levels. HscTnT levels ≤ 5 ng/L were associated with a 4% (95% confidence interval [CI] = 3%–5%) outcome risk, and hscTnT > 50 ng/L, a 29% (95% CI = 26%–33%) risk. NT-proBNP levels ≤ 125 ng/L were associated with a 4% (95% CI = 4%–5%) risk, and NT-proBNP > 2,000 ng/L a 29% (95% CI = 25%–32%) risk. Likelihood ratios and predictive values demonstrated similar results. Sensitivity analyses excluding ED index serious outcomes demonstrated similar findings. Conclusions: hscTnT and NT-proBNP are independent predictors of 30-day death and serious outcomes in older ED patients presenting with syncope.
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U2 - 10.1111/acem.13709
DO - 10.1111/acem.13709
M3 - Article
C2 - 30721554
AN - SCOPUS:85062519842
SN - 1069-6563
VL - 26
SP - 528
EP - 538
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 5
ER -