Reduced performance of Troponin T for acute coronary syndromes diagnosis in the elderly and very elderly patients: results of a 2688 patients retrospective study

M. Covino*, B. Simeoni*, M. Montalto°, F. Burzotta§, F. Buccelletti*, L. Carbone*, A. Gallo°, N. Gentiloni Silveri*

*Department of Emergency Medicine, °Department of Internal Medicine, §Department of Cardiovascular Medicine, School of Medicine, Catholic University of the Sacred Heart, Rome (Italy)

---

• Emergency Medicine

Study Objective: We evaluated the performance of Troponin T (cTnT) for acute coronary syndrome (ACS) diagnosis in elder compared to younger patients.

Materials and Methods: We retrospectively evaluated 2688 patients admitted to our Emergency Department for suspected ACS. All patients received ECG, serum creatinine determination, and serial cTnT samplings. Patients were considered positive for cTnT if they had a cTnT above our reference standard (> 0.03 µg/L) in any determination obtained within 6 hours from admission. ACS diagnosis, either acute myocardial infarction or unstable angina, was based on reviewed data and discharge diagnosis hospital. Patients were divided in three groups according to age: < 65 years old, elders ≥ 65 and < 80 years, and very elders ≥ 80 years. CTnT diagnostic accuracy for ACS was compared in these three groups in patients < 65 years.

Results: Two thousands six and hundred eighty-eight patients (35.3% female) were enrolled in this study. 1087 patients (40.4%) were < 65 years old, while 1205 patients (44.8%) were ≥ 65 and < 80 years, and 396 patients (14.8%) were ≥ 80 years. The overall sensitivity of cTnT for ACS diagnosis was 0.57 (CI 95% 0.54-0.60) with a specificity of 0.71 (CI 95% 0.69-0.73). In older cohorts cTnT showed a reduced performance for ACS diagnosis. Area under the receiver operating characteristic curve of abnormal cTnT for ACS was 0.70 (0.66-0.73) in < 65 years, 0.61 (95% CI 0.60-0.66) in ≥ 65 and < 80 years, and 0.59 (0.53-0.65) in ≥ 80 years.

Conclusion: Compared to younger patients cTnT showed a reduced performance for ACS diagnosis in elders ≥ 65 and < 80 years; cTnT performance was further reduced in patients ≥ 80 years.

Corresponding Author: Marcello Covino, MD; e-mail: macovino@gmail.com

Published on: 2012/10/17

Free PDF Download