Klinisk prövning på Perioperative Myocardial Infarctions

Troponin med hög känslighet kan förutsäga Perioperativ MI-risk

In 974 patients (77.1%) with both 0-hour and 3-hour hsTnT levels of 19 ng/L or less, the negative predictive value for 30-day ACE was 99.3% (95% CI, 99.1-99.6). The hsTnT value was measured immediately before surgery and in the morning of the first postoperative day. RESULTS: The baseline hsTnT was 13 ng/L (7-26 ng/L) and 273 patients (45.7%) had baseline hsTnT above the 99th percentile/upper reference limit (URL) (14 ng/L). The median for hsTnT at first postoperative day was 235 ng/L (152-425 ng/L). We hypothesized that baseline N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) and high‐sensitivity troponin T (hsTnT) levels would help identify patients who are at higher baseline risk and we describe the treatment effects of dapagliflozin in patients according to their baseline NT‐proBNP and hsTnT levels. Methods and results Methods and Results: In the British Regional Heart Study, 3852 men aged 60 79 years without baseline HF (3165 without baseline chronic heart disease) were followed for a median of 12.6 years, during which 295 incident cases of HF occurred (7.7%).

As myocardial injury identifies patients at higher risk, the absence of injury at baseline may identify low-risk patients. Objective: To determine if a baseline hsTnT value ≤99th percentile upper reference limit (0.014 ug/L (“low hsTnT”)) identifies patients at low risk for adverse events. At baseline, samples for hsTnT measurement were taken in ethylenediamine tetraacetic acid tubes, centrifuged, and stored at −80 °C until analysis was performed for all samples at the same time point. Plasma hsTnT were measured by Elecsys diagnostics (Roche, Berlin, Germany) and with a detection limit of 0.01 ng/l (0.00001 μg/l).

Troponinnivåer ger nu bättre hjälp vid misstänkt hjärtinfarkt

Increased baseline hsTnT levels occurred in 78% of all patients. Peri-procedural myocardial infarction was not registered in any of the two groups (Table 2). hsTnT elevated at baseline, NT-pro-BNP and right ventricular function were determinants of death (p < 0.05 for all).

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The median time from symptom onset to ED presentation was 2.9 hours, while time from symptom onset to baseline hsTnT was 5.8 hours. Clinicians should consider that the performance characteristics of hsTnT may not be duplicated at earlier times. Severe hypoglycemia was associated with 34% higher 1-year hsTnT levels (p < 0.0001) in unadjusted analysis, 17% higher (p = 0.006) after adjustment for baseline factors unrelated to diabetes, and 6% higher (p = 0.23) after further adjustment for the duration and severity of diabetes.

hsTnT were available in 888 patients (438 without diabetic nephropathy, 450 with diabetic nephropathy). Of these, 104 patients had hsTnT levels below the detection limit. At baseline, hsTnT was higher in patients with diabetic ne-phropathy than in patients with normoalbuminuria (median [interquartile range]: 8.9 [4.1–17.2] vs. 3.1 [1.1–6.0 Combination of baseline hsTnT levels with the sPESI allowed a more reliable identification of patients with a favorable long-term (6-month) prognosis (Figure 3, bottom, P<0.001; and Figure 4). Only 1 patient (0.8 [0.0–4.3]%) with a sPESI of 0 and hsTnT <14 pg/mL died within the 6-month follow-up period. This is seemingly contradicted by Reichlin et al., who claimed that a simple algorithm incorporating hsTnT baseline values and absolute changes within the first hour allowed a safe rule-out and an accurate rule-in of AMI in 77% of randomly selected patients with acute chest pain [65]. However, the relationship between hsTnT and renal outcomes remained strong (p < 0.001) even after adjusting for baseline eGFR.
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Highly sensitive troponin T values ranged from 0.001 to 357.2 pg/mL [median 27.2 (25th-75th percentile 9.4-69.4) pg/mL]. The hsTnT value was measured immediately before surgery and in the morning of the first postoperative day. RESULTS: The baseline hsTnT was 13 ng/L (7-26 ng/L) and 273 patients (45.7%) had baseline hsTnT above the 99th percentile/upper reference limit (URL) (14 ng/L). The median for hsTnT at first postoperative day was 235 ng/L (152-425 ng/L). Baseline NT‐proBNP and hsTnT levels were measured in the TIMI Clinical Trials Laboratory in 14 565 patients.

Table 1. doi 28 Dec 2020 Treatment with dapagliflozin was associated with a reduced relative risk of CV death/HHF for all baseline hsTnT and NT-proBNP levels.
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Troponin med hög känslighet kan förutsäga Perioperativ MI-risk

You either set it for a single assay, in which case all wells for that Baseline STM gives you the tools to accomplish this. Effective means using your own power and talent to improve your competence and talent and also learning 16 Apr 2018 1.

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Troponinnivåer ger nu bättre hjälp vid misstänkt hjärtinfarkt

doi 28 Dec 2020 Treatment with dapagliflozin was associated with a reduced relative risk of CV death/HHF for all baseline hsTnT and NT-proBNP levels. In multivariable linear regression analysis, there were significant correla- tions between hsTnT at baseline and age, male gender, creatinine, left ventricular mass generational troponin T assays. We hypothesize that similar to previous assays, concentrations of high-sensitivity troponin T. (hsTnT) on the 1st and 2nd 22 Mar 2021 Prognostic role of hsTnT.

Troponinnivåer ger nu bättre hjälp vid misstänkt hjärtinfarkt

Result > 100 ? > 6 hrs of symptoms? 2 ndhsTnT (taken at >6 hours post symptom onset AND >3 hours from 1st test) 1st or 2 Result > 14 and > 50% change ? YES YES NO NO YES NO When investigating an acute MI, order the hsTnT test. If there is no previous hsTnT in the past 12 hours, the test will be considered a baseline hsTnT, whereas if a previous hsTnT has been measured within the past 12 hours, the test will be considered a follow-up hsTnT (see appendix B). The baseline hsTnT result is reported When investigating an acute MI, order the hsTnT test.

placebo. Whereas hsTnT levels were <14 ng/L (limit of quantification) in these control subjects (3.34 ng/L, 3.96 ng/L and 5.97 ng/L), hsTnT baseline values were >14 ng/L and thus pathologically elevated in 4 patients. Elevated hsTnT levels are associated with death and decreased right ventricle function in patients with PAH . A rule-out strategy based on a single hsTnT at presentation and using lower cutoffs has been proposed by others.