Early diagnosis of XXXX in the elderly using more sensitive cardiac troponin assays.

@entity1 @entity583 @entity10020 @entity6949
AIMS: To examine the diagnostic accuracy of sensitive cardiac troponin (cTn) assays in elderly @entity1 , since elevated levels with sensitive cTn assays were reported in 20% of elderly @entity1 without @entity583 ( @entity583 ). METHODS AND RESULTS: In this multi-centre study, we included 1098 consecutive @entity1 presenting with symptoms suggestive of @entity583 , 406 (37%) were >70 years old. Measurement of three investigational sensitive cTn assays [Roche high-sensitive @entity10020 (hs- @entity10020 ), Siemens @entity6949 -Ultra, and Abbott-Architect @entity6949 ) and the standard assay (Roche @entity10020 ) was performed in a blinded fashion. The final diagnosis was adjudicated by two independent cardiologists. Acute @entity583 was the adjudicated final diagnosis in 24% of elderly @entity1 . Among elderly @entity1 without @entity583 , baseline cTn levels were elevated above the 99th percentile in 51% with Roche hs- @entity10020 , in 17% with Siemens TnI-Ultra, and 13% with Abbott-Architect @entity6949 . The diagnostic accuracy as quantified by the area under the receiver operating characteristic (ROC) curve (AUC) was significantly greater for the sensitive cTn assays compared with the standard assay (AUC for Roche hs- @entity10020 , 0.94; Siemens @entity6949 -Ultra, 0.95; and Abbott-Architect @entity6949 , 0.95 vs. AUC for the standard assay, 0.90; P < 0.05 for comparisons). The best cut-offs for the sensitive cTn-assays determined by the ROC-curve in elderly @entity1 differed clearly from those in younger @entity1 . Furthermore, the prognostic value regarding 90-day mortality varied among the sensitive cTn assays. CONCLUSION: Sensitive cTn assays have high diagnostic accuracy also in the elderly. Mild elevations are common in elderly non- @entity583 @entity1 , therefore the optimal cut-off levels are substantially higher in elderly as compared with younger @entity1 . Furthermore, sensitive cTn assays yielded different prognostic value.
