In:
Academic Emergency Medicine, Wiley, Vol. 26, No. 5 ( 2019-05), p. 528-538
Abstract:
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 ‐pro BNP ) are unclear. The objective of this study was to determine if hscTnT and NT ‐pro BNP 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 ‐pro BNP 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 ‐pro BNP 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 ‐pro BNP levels ≤ 125 ng/L were associated with a 4% (95% CI = 4%–5%) risk, and NT ‐pro BNP 〉 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 ‐pro BNP are independent predictors of 30‐day death and serious outcomes in older ED patients presenting with syncope.
Type of Medium:
Online Resource
ISSN:
1069-6563
,
1553-2712
DOI:
10.1111/acem.2019.26.issue-5
Language:
English
Publisher:
Wiley
Publication Date:
2019
detail.hit.zdb_id:
2029751-8
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