Company insight Stratifying cardiac risk
Cardiovascular diseases are still the main cause of mortality in the world, and this trend is unfortunately destined to grow, according to the WHO. About 47% of sudden cardiac deaths occur outside a hospital, suggesting that many people with heart disease don’t act on early warning signs. Abbott’s High Sensitive Troponin-I can help to more accurately identify elevated risk of a future cardiac event, even in apparently healthy individuals.
bbott’s High Sensitive Troponin-I (hsTnI) cardiac-specific biomarker is the first CE-marked laboratory test that aids in predicting future cardiac events in asymptomatic individuals. In conjunction with clinical and diagnostic findings, it may be used to help stratify the risk of cardiovascular disease (CVD), including cardiovascular death, myocardial infarction (MI), coronary revascularisation, heart failure or ischemic stroke in asymptomatic individuals.
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Why Abbott’s hsTnI? Abbott’s hsTnI is the first biomarker to use the unmatched power of cardiac specificity, substantiated by published studies of over 100,000 people, to help identify the risk of future cardiac events in the apparently healthy population. It can be used across care settings and integrated into clinical practice as part of existing wellness checks.
Abbott’s hsTnI and its uses Abbott’s hsTnI test is a chemiluminescent, microparticle immunoassay for the quantitative determination of cardiac troponin I in human plasma and serum. The cardiac troponin I values can be used: ■
In asymptomatic individuals: in conjunction with clinical and diagnostic findings. It aids the categorisation of asymptomatic individuals at risk of CVD, including cardiovascular death, MI, coronary revascularisation, heart failure (HF) or ischemic stroke.
Figure 1: Limitations of various CV risk scoring systems Risk scoring system
Limitations European SCORE risk chart
Estimates only fatal CV risk May not be applicable in non-European populations Limited to the major determinants of risk Limited age range (40–65 years)
SCVD risk score calculator (AHA/ACC)
Framingham Risk Score
May overestimate CV risk in both men and women Inferior to the Framingham Risk Score in identifying high CV risk individuals when evaluated in an Asian population
May overestimate CV risk in both men and women
May not be accurate in those with markedly elevated risk factors (such as those with markedly elevated LDL levels)
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In emergency departments: As an aid in the diagnosis of MI and to aid in the assessment of 30-day and 90-day prognosis relative to all-cause mortality and major adverse cardiac events consisting of MI, revascularisation, and cardiac death in patients who present with symptoms suggestive of acute coronary syndrome (ACS).
Stratifying risk in
asymptomatic individuals There are a variety of cardiovascular (CV) risk prediction models currently available, many of which estimate CV risk by taking into account the presence of CV risk factors. This method of stratifying CV risk poses challenges, in particular in the local setting and between patients of different ethnicities. Existing models also have specific limitations,
Figure 2: Cut-off points in categorising the risk of asymptomatic CVD Troponin level
Interpretation
Male (pg/ml) <6
≥6 to ≤12 >12
Female (pg/ml) <4
≥4 to ≤10 >10
Practical Patient Care /
www.practical-patient-care.com Low risk of future heart attack
Moderate risk of future heart attack Elevated risk of future heart attack
such as applicability only in certain populations and the ability to measure only a limited number of CV outcomes (Figure 1).
CV risk stratification of
asymptomatic patients using hsTnI Abbott’s hsTnI blood test can more accurately predict which asymptomatic individual is likely to be at low, moderate or elevated risk for future adverse cardiac events. It enables the care of those at higher risk to be prioritised to help prevent adverse outcomes. The following cut-off points (Figure 2) may be used to aid in categorising the risk of CVD in asymptomatic individuals. This strategy provides greater accuracy in identifying lower risk patients and may avoid unnecessary investigations, treatments and potential side effects, compared with existing risk stratification tools.
What is risk stratification? Risk stratification, in this context, refers to the use of hsTnI as a tool for identifying and predicting who is likely to be at low, moderate or elevated risk for future adverse cardiac events, such as heart attack, heart failure or death. ●
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