Single High-Sensitivity Cardiac Troponin I to Rule Out Acute Myocardial Infarction

Sandoval, Yader; Smith, Stephen W.; Love, Sara A.; Sexter, Anne; Schulz, Karen; Apple, Fred S.

doi:10.1016/j.amjmed.2017.02.032

Cited by 58 publications

(44 citation statements)

References 23 publications

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“…For patients with more than one presentation during the study period, we included only the first; 1631 patients without ST elevation MI were enrolled in the UTROPIA Study cohort. 3,4 The Concise Methods sections of refs. 3 and 4 have more detailed information of the primary goals of the UTROPIA Study.…”

Section: Concise Methodsmentioning

confidence: 99%

“…Cardiac troponin I (cTnI) and cardiac troponin T (cTnT) are sensitive biomarkers of myocardial injury, and they are routinely used to diagnose acute myocardial infarction (MI). [1][2][3][4] Although cardiac troponin (cTn) testing is highly specific for myocardial injury, multiple disease states in addition to MI can lead to myocardial injury and cTn increases above the 99th percentile, including CKD. [1][2][3][4][5][6][7][8] Patients with CKD can have increased cTn concentrations in the absence of MI, 8 a finding that has been postulated to be caused by chronic structural heart disease rather than acute injury.…”

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confidence: 99%

“…[1][2][3][4] Although cardiac troponin (cTn) testing is highly specific for myocardial injury, multiple disease states in addition to MI can lead to myocardial injury and cTn increases above the 99th percentile, including CKD. [1][2][3][4][5][6][7][8] Patients with CKD can have increased cTn concentrations in the absence of MI, 8 a finding that has been postulated to be caused by chronic structural heart disease rather than acute injury. 5,6 One misconception by clinicians is that increased cTn concentrations in renal impaired patients are due to impaired renal elimination of cTn, a mechanism that has not been proven to date for cTnI but for cTnT, seems to be influenced by kidney function.…”

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Renal Dysfunction Influences the Diagnostic and Prognostic Performance of High-Sensitivity Cardiac Troponin I

Gunsolus¹,

Sandoval

Smith³

et al. 2017

JASN

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Measures of cardiac troponin (cTn) may have lower specificity for myocardial infarction in patients with CKD. We examined the diagnostic accuracy of baseline and serial high-sensitivity cTnI (hs-cTnI) measurements for myocardial infarction and 30- and 180-day mortality according to renal function. hs-cTnI was measured (Abbott assay) using sex-specific 99th percentiles (women, 16 ng/L; men, 34 ng/L) in 1555 adults presenting to the emergency department with symptoms suggesting ischemia (NCT02060760). Myocardial infarction was adjudicated along universal definition classification. Renal function did not significantly affect sensitivity or negative predictive values. Specificity decreased with impaired renal function from 93%-95% with normal function (eGFR≥90 ml/min per 1.73 m; =722) to 57%-61% with severely impaired renal function (eGFR<30 ml/min per 1.73 m; =81) and 40%-41% on dialysis (=78). Positive predictive values decreased with decreasing renal function from 51%-57% with normal function to 27%-42% with severely impaired function and 15%-32% on dialysis. Receiver operating characteristic curve areas trended lower at baseline and 3 hours with renal impairment. Mortality increased significantly with increasing hs-cTnI tertile (1.3%, 6.0%, and 10.4%, respectively). Patients with hs-cTnI concentration exceeding concentrations in the 99th percentiles had a mortality rate (11.7%) significantly higher than that of patients with concentrations between 99th percentile concentrations and limit of detection (6.2%) or below limit of detection (1.1%). Renal dysfunction and dialysis reduced the rule-in performance but not the rule-out performance of hs-cTnI for myocardial infarction, and mortality increased in patients with higher hs-cTnI concentrations and any level of renal dysfunction.

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Section: Concise Methodsmentioning

confidence: 99%

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Renal Dysfunction Influences the Diagnostic and Prognostic Performance of High-Sensitivity Cardiac Troponin I

Gunsolus¹,

Sandoval

Smith³

et al. 2017

JASN

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“…Cardiac troponin T and I (cTnT and cTnI) are accepted indicators of myocyte necrosis and are considered sensitive markers of acute myocardial injury (MI) and infarction (AMI) (75). Serum cTnT and cTnI are elevated after irreversible heart muscle damage and levels peak during the subsequent days (1,60). The N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) is a marker accepted to reflect myocardial stretch (74), which is currently used to detect heart failure and asymptomatic left ventricular dysfunction (14,53) with the magnitude and duration of release dependent on the severity of stretch and stress (3).…”

Section: Introductionmentioning

confidence: 99%

Cardiac Biomarker Release After Exercise in Healthy Children and Adolescents: A Systematic Review and Meta-Analysis

Cirer-Sastre

Legaz-Arrese

Corbi

et al. 2019

Pediatric Exercise Science

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Purpose:The authors evaluated the impact of acute exercise and 24-hour recovery on serum concentration of cardiac troponins T and I (cTnT and cTnI) and N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) in healthy children and adolescents. The authors also determined the proportion of participants exceeding the upper reference limits and acute myocardial infarction cutoff for each assay.Method:Web of Science, SPORTDiscus, MEDLINE, ScienceDirect, and Scopus databases were systematically searched up to November 2017. Studies were screened and quality-assessed; the data was systematically extracted and analyzed.Results:From 751 studies initially identified, 14 met the inclusion criteria for data extraction. All 3 biomarkers were increased significantly after exercise. A decrease from postexercise to 24 hours was noted in cTnT and cTnI, although this decrease was only statistically significant for cTnT. The upper reference limit was exceeded by 76% of participants for cTnT, a 51% for cTnI, and a 13% for NT-proBNP. Furthermore, the cutoff value for acute myocardial infarction was exceeded by 39% for cTnT and a 11% for cTnI. Postexercise peak values of cTnT were associated with duration and intensity (Q(3) = 28.3,P < .001) while NT-proBNP peak values were associated with duration (Q(2) = 11.9,P = .003).Conclusion:Exercise results in the appearance of elevated levels of cTnT, cTnI, and NT-proBNP in children and adolescents. Postexercise elevations of cTnT and NT-proBNP are associated with exercise duration and intensity.

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“…Cardiac troponin I (cTnI) and cardiac troponin T (cTnT), which are sensitive biological markers of myocardial injury, are used to diagnose acute myocardial infarction (AMI) [1][2][3][4]. Although cardiac troponin (cTn) testing is quite specific in detecting myocardial damage, multiple diseases, including chronic kidney disease (CKD), may lead to injury that increases cTn [1][2][3][4][5][6][7][8]. In patients with CKD, cTn concentrations may be elevated in the absence of AMI [8], which is a predicted finding caused by chronic structural heart disease rather than acute injury [5,6].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Relationship between Early Troponin Clearance and Short-Term Mortality in Patients with Chronic Renal Failure

Özbek¹,

Algın

Gökhan

et al. 2020

Emergency Medicine International

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Objective. In patients with CKD, cTn concentrations may be elevated in the absence of AMI, which is a predicted finding caused by chronic structural heart disease rather than acute injury. The increase in troponin level observed in noncardiac conditions provides conflicting results when predicting mortality. Low lactate clearance was associated with increased mortality. Lactate clearance is calculated as follows: (early lactate − late lactate/early lactate) ∗ 100. We aimed to investigate whether troponin clearance calculated according to this formula had an effect on short-term mortality. Methods. The study included 300 patients with chronic renal failure who had a sepsis-related organ failure assessment (SOFA) score ≥3. By taking the baseline troponin at the time of emergency presentation as reference and comparing them with the fourth-hour troponin values, troponin clearance was investigated in the evaluation of mortality among hospitalized patients with CKD within the first month after discharge. The data obtained were analyzed using the SPSS data analysis software version 20.0. Student’s t-test was used for the parametric data, and the Chi-squared test for the nonparametric data. Results. Of the 300 patients evaluated, 189 patients survived (mean age 66.20 ± 14.597 years), and 111 died (mean age 74.81 ± 12.916 years). Troponin clearance was detected in 40 of the 111 patients in the mortality group and 119 of the 189 patients in the survival group. Troponin clearance was significantly more frequent in surviving patients (P=0.0000083). Conclusion. Troponin clearance can be considered as a valuable leading indicator of survival, but higher levels of troponin clearance did not lead to higher survival rates.

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Single High-Sensitivity Cardiac Troponin I to Rule Out Acute Myocardial Infarction

Abstract: Strategies using a single hs-cTnI alone or in combination with a normal ECG allow the immediate identification of patients unlikely to have acute myocardial infarction and who are at very low risk for adverse events at 30 days.

Cited by 58 publications

References 23 publications

Renal Dysfunction Influences the Diagnostic and Prognostic Performance of High-Sensitivity Cardiac Troponin I

Renal Dysfunction Influences the Diagnostic and Prognostic Performance of High-Sensitivity Cardiac Troponin I

Cardiac Biomarker Release After Exercise in Healthy Children and Adolescents: A Systematic Review and Meta-Analysis

Evaluation of the Relationship between Early Troponin Clearance and Short-Term Mortality in Patients with Chronic Renal Failure

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