Non-ST Segment Elevation Acute Coronary Syndromes and High- Sensitivity Cardiac Troponin T: Is this the End of the Conservative Strategy?

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Abstract

Background: An invasive strategy is recommended in high-risk non-ST segment elevation acute coronary syndromes with elevated high-sensitivity cardiac troponin T levels.
Objectives: The aim of this study was to evaluate in-hospital events in patients undergoing a conservative strategy, analyze the prevalence of elevated high-sensitivity cardiac troponin T levels and its correlation with in-hospital events and establish the predictive value of the biomarker for in-hospital events comparing it with a clinical risk model.
Methods: We conducted an observational and retrospective study. Patients admitted to a coronary care unit with non-ST segment elevation acute coronary syndrome in two centers and treated with a conservative strategy between 2012 and 2017 were included. The clinical risk model was based on the TIMI risk score using the following variables: age > 65 years, two episodes of angina or greater within the past 24 hours, electrocardiographic changes, coronary risk factors, history of coronary artery disease and previous
aspirin, excluding high-sensitivity cardiac troponin T levels. The predictive value of high-sensitivity cardiac troponin was compared with the clinical risk model to predict in-hospital events using ROC curves. Combined in-hospital events: recurrent angina, myocardial infarction and mortality. High-sensitivity cardiac troponin T levels > 14 pg/dL were considered elevated.
Results: A total of 245 patients were included. Median age was 65 years (57-76) and 74% were men. Median clinical risk score was 3 (1-4) and 65% of the patients had elevated high-sensitivity cardiac troponin levels. In-hospital events: 55/245 patients (22.4%): recurrent angina, 20,4%; Q-wave myocardial infarction,1.6%; mortality, 0.4%. The prognostic accuracy of high-sensitivity cardiac troponin T to predict in-hospital events was 0.56 (0.48-0.65) compared with the clinical risk model [0.58 (0.49-0.67); p = 0.92] and
the TIMI risk score (0.56; p: 0.16).
Conclusions: In patients with non-ST segment elevation acute coronary syndrome, neither high-sensitivity cardiac troponinT levels nor clinical variables were consistent to predict in-hospital events. High-sensitivity cardiac troponin T levels used to guide the therapeutic strategy could lead to an unnecessary indication of procedures with the associated inherent risk.