Do High-sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?

Carol L. Clark, Thomas A. Gibson, Robert E. Weiss, Annick N. Yagapen, Susan E. Malveau, David H. Adler, Aveh Bastani, Christopher W. Baugh, Jeffrey M. Caterino, Deborah B. Diercks, Judd E. Hollander, Bret A. Nicks, Daniel K. Nishijima, Manish N. Shah, Kirk A. Stiffler, Alan B. Storrow, Scott T. Wilber, Benjamin Sun

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalAcademic Emergency Medicine
DOIs
StatePublished - Jan 1 2019

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Natriuretic Peptides
Troponin
Syncope
Hospital Emergency Service
Confidence Intervals
Biomarkers
Monte Carlo Method
Markov Chains
State Hospitals
Transient Ischemic Attack
pro-brain natriuretic peptide (1-76)
Hypoglycemia
Seizures
Logistic Models
Stroke
Regression Analysis
Mortality
Wounds and Injuries

ASJC Scopus subject areas

  • Emergency Medicine

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Do High-sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope? / Clark, Carol L.; Gibson, Thomas A.; Weiss, Robert E.; Yagapen, Annick N.; Malveau, Susan E.; Adler, David H.; Bastani, Aveh; Baugh, Christopher W.; Caterino, Jeffrey M.; Diercks, Deborah B.; Hollander, Judd E.; Nicks, Bret A.; Nishijima, Daniel K.; Shah, Manish N.; Stiffler, Kirk A.; Storrow, Alan B.; Wilber, Scott T.; Sun, Benjamin.

In: Academic Emergency Medicine, 01.01.2019.

Research output: Contribution to journalArticle

Clark, CL, Gibson, TA, Weiss, RE, Yagapen, AN, Malveau, SE, Adler, DH, Bastani, A, Baugh, CW, Caterino, JM, Diercks, DB, Hollander, JE, Nicks, BA, Nishijima, DK, Shah, MN, Stiffler, KA, Storrow, AB, Wilber, ST & Sun, B 2019, 'Do High-sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?', Academic Emergency Medicine. https://doi.org/10.1111/acem.13709
Clark, Carol L. ; Gibson, Thomas A. ; Weiss, Robert E. ; Yagapen, Annick N. ; Malveau, Susan E. ; Adler, David H. ; Bastani, Aveh ; Baugh, Christopher W. ; Caterino, Jeffrey M. ; Diercks, Deborah B. ; Hollander, Judd E. ; Nicks, Bret A. ; Nishijima, Daniel K. ; Shah, Manish N. ; Stiffler, Kirk A. ; Storrow, Alan B. ; Wilber, Scott T. ; Sun, Benjamin. / Do High-sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?. In: Academic Emergency Medicine. 2019.
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abstract = "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.",
author = "Clark, {Carol L.} and Gibson, {Thomas A.} and Weiss, {Robert E.} and Yagapen, {Annick N.} and Malveau, {Susan E.} and Adler, {David H.} and Aveh Bastani and Baugh, {Christopher W.} and Caterino, {Jeffrey M.} and Diercks, {Deborah B.} and Hollander, {Judd E.} and Nicks, {Bret A.} and Nishijima, {Daniel K.} and Shah, {Manish N.} and Stiffler, {Kirk A.} and Storrow, {Alan B.} and Wilber, {Scott T.} and Benjamin Sun",
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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

PY - 2019/1/1

Y1 - 2019/1/1

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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