PMID- 36041986 OWN - NLM STAT- MEDLINE DCOM- 20221216 LR - 20221216 IS - 1444-2892 (Electronic) IS - 1443-9506 (Linking) VI - 31 IP - 11 DP - 2022 Nov TI - Clinically Acquired High Sensitivity Cardiac Troponin T is a Poor Predictor of Reduced Left Ventricular Ejection Fraction After ST Elevation Myocardial Infarction: A National Cohort Study-ANZACS-QI 65. PG - 1513-1523 LID - S1443-9506(22)01039-3 [pii] LID - 10.1016/j.hlc.2022.07.014 [doi] AB - OBJECTIVE: Cardiac troponins (cTn) have been used historically to estimate infarct size in ST elevation myocardial infarction (STEMI). Within a resource constrained health care environment, cTn could therefore be used for prioritisation of patients for cardiac imaging, in particular echocardiography. We aimed to determine how useful routinely collected cTn would be in predicting significant left ventricular (LV) impairment. METHODS: All patients in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry with their first episode of STEMI between January 2013 and November 2018, who had high sensitivity troponin T measured, were included. We excluded patients with no left ventricular ejection fraction (LVEF) assessment, known LV dysfunction, or prior myocardial infarction. RESULTS: In total, 3,698 patients were included in the analysis. A higher mean hsTnT (admission and peak) was seen in patients with more severely impaired LV function but there was significant overlap in the range of hsTnT between the different LVEF categories. Cardiac troponins demonstrated poor discriminative ability to either predict or exclude significant LV impairment (LVEF <40%). At an optimal cutpoint of 3,405 ng/L, peak hsTnT had a sensitivity of 56.5% (95% confidence interval [CI] 42-62%), a specificity of 65.3% (95% CI 62-79%) and an area under the receiver operating curve of 0.62 (95% CI 0.60-0.64). CONCLUSION: This is the largest study comparing clinically measured troponin levels and LV function in patients presenting with STEMI. A definite, but weak, association was seen between peak troponin and the degree of LV dysfunction, with significant overlap in troponin levels between levels of myocardial dysfunction. Routinely acquired troponin is not suitable for clinical use as a method of prioritising patients for cardiac imaging. CI - Copyright (c) 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved. FAU - McLeod, Peter AU - McLeod P AD - Department of Medicine - HeartOtago, Otago Medical School, University of Otago, Dunedin, New Zealand; Department of Cardiology, Southern District Health Board, Dunedin, New Zealand. Electronic address: Peter.McLeod@otago.ac.nz. FAU - Coffey, Sean AU - Coffey S AD - Department of Medicine - HeartOtago, Otago Medical School, University of Otago, Dunedin, New Zealand; Department of Cardiology, Southern District Health Board, Dunedin, New Zealand. FAU - Sneddon, Katherine AU - Sneddon K AD - Department of Medicine - HeartOtago, Otago Medical School, University of Otago, Dunedin, New Zealand. FAU - Williams, Michael AU - Williams M AD - Department of Medicine - HeartOtago, Otago Medical School, University of Otago, Dunedin, New Zealand; Department of Cardiology, Southern District Health Board, Dunedin, New Zealand. FAU - Kerr, Andrew AU - Kerr A AD - School of Population Health and Department of Medicine, University of Auckland, Auckland, New Zealand; Cardiology Department, Middlemore Hospital, Auckland, New Zealand. FAU - Pemberton, James AU - Pemberton J AD - Department of Medicine - HeartOtago, Otago Medical School, University of Otago, Dunedin, New Zealand; Department of Cardiology, Southern District Health Board, Dunedin, New Zealand. LA - eng PT - Journal Article DEP - 20220827 PL - Australia TA - Heart Lung Circ JT - Heart, lung & circulation JID - 100963739 RN - 0 (Troponin) RN - 0 (Troponin T) SB - IM MH - Humans MH - Cohort Studies MH - *Percutaneous Coronary Intervention/methods MH - Prognosis MH - *ST Elevation Myocardial Infarction/diagnosis MH - Stroke Volume MH - Troponin MH - Troponin T MH - *Ventricular Dysfunction, Left/diagnosis MH - Ventricular Function, Left OTO - NOTNLM OT - Left ventricular function OT - ST elevation myocardial infarction OT - Troponin T EDAT- 2022/08/31 06:00 MHDA- 2022/11/30 06:00 CRDT- 2022/08/30 22:15 PHST- 2021/11/01 00:00 [received] PHST- 2022/06/27 00:00 [revised] PHST- 2022/07/18 00:00 [accepted] PHST- 2022/08/31 06:00 [pubmed] PHST- 2022/11/30 06:00 [medline] PHST- 2022/08/30 22:15 [entrez] AID - S1443-9506(22)01039-3 [pii] AID - 10.1016/j.hlc.2022.07.014 [doi] PST - ppublish SO - Heart Lung Circ. 2022 Nov;31(11):1513-1523. doi: 10.1016/j.hlc.2022.07.014. Epub 2022 Aug 27.