Predictive role of high sensitivity troponin T within four hours from presentation of XXXX in elderly @entity1 .

@entity662 @entity1 @entity1187 @entity341 @entity2286 @entity583
BACKGROUND: Previous studies indicate that the introduction of high-sensitivity troponin T (HsTnT) as a diagnostic tool for @entity662 @entity1 in the @entity341 ( @entity341 ) creates a high rate of false-positive tests. In the present study, we aimed to evaluate if the diagnostic performance of HsTnT for @entity1187 ( @entity1187 ) up to 3-4  h after presentation in elderly @entity1 can be improved. METHODS: A total of 477 consecutive @entity1   >=    75  years, admitted to in-hospital care for @entity662 suspicious of @entity1187 , were retrospectively included. HsTnT values at presentation (0  h) and at 3-4  h were analysed. Receiver operating characteristic (ROC) curves were created for absolute and relative changes from 0 to 3-4  h. @entity1187 , non-elective percutaneous coronary intervention, coronary artery bypass grafting and death of all causes were recorded for all @entity1 during a follow-up of 60  days. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value ( @entity2286 ) were analysed for different HsTnT cut-off values at 0 and 3-4  h and for the combination of a HsTnT at presentation and an absolute change from 0 to 3-4  h. RESULTS: Twenty-seven percent of the @entity1 had @entity1187 and 21  % @entity583 ( @entity583 ) during the hospital stay. The standard cut-off 14  ng/L gave sensitivity and NPV for @entity1187 of 88 and 90  % at 3-4  h. Specificity and @entity2286 was 38 and 32  % respectively. Analysing for @entity583 ( @entity583 ) alone gave a sensitivity and NPV of 100  % but did not improve specificity and @entity2286 . The area under the ROC-curve was larger for absolute than relative HsTnT changes from 0 to 3-4  h. A combination of HsTnT at presentation   >   30  ng/L and/or a change   >   5  ng/L up to 3-4  h gave a 63  % specificity and a @entity2286 of 46  %, a 99  % sensitivity and a NPV of 99  % for @entity583 . CONCLUSION: Our study indicates that HsTnT can neither exclude nor confirm @entity1187 within 3-4  h from presentation in @entity1   >=    75  years. @entity583 can be excluded with HsTnT within 3-4  h, but HsTnT cannot be used to rule in @entity583 during the first 3-4  h, not even by using a combination of the initial HsTnT result and the change from 0 to 3-4  h. With combined criteria, the majority of the positive tests were still false positive. Our results indicate that in @entity1   >   75  years, HsTnT should be used primarily as an early rule-out tool for @entity583 .
