Comparison of high sensitivity and contemporary troponin assays for the early detection of acute myocardial infarction in the emergency department

Aldous, Sally; Florkowski, Chris; Crozier, Ian; Elliott, John; George, Peter M.; Lainchbury, John G.; Mackay, Richard; Than, Martin; Flaws, Dylan; Borowsky, Jennifer

doi:10.1258/acb.2010.010219

Cited by 60 publications

(69 citation statements)

References 25 publications

(71 reference statements)

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“…Aldous et al examined the introduction of the suggested time-dependent delta-change criterium for the diagnosis of acute MI in the ED (49): Introduction of the diagnostic criterium that a time-dependent increase (or fall) of hs-cTn )50% is necessary to diagnose acute MI increase specificity )95% at the cost of sensitivity (hs-cTnT: 61.8%; hs-cTnI: 68.2%). These findings support the notion that diagnostic reasoning in emergency medicine cannot be reduced to pure mathematical calculations of biomarker concentrations (49,50). Diagnostic reasoning and deduced therapeutic management strategies can only be made correctly, when all available information about the patient is used.…”

Section: Time-dependent Changes Of Troponin Levels In Acute Myocardiasupporting

confidence: 73%

High-sensitivity troponin assays in the evaluation of patients with acute chest pain in the emergency department

Christ

Bertsch

Popp

et al. 2011

Clinical Chemistry and Laboratory Medicine (CCLM)

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Evaluating patients with acute chest pain presenting to the emergency department remains an ongoing challenge. The spectrum of etiologies in acute chest pain ranges from minor disease entities to life-threatening diseases, such as pulmonary embolism, acute aortic dissection or acute myocardial infarction (MI). The diagnosis of acute MI is usually made integrating the triad of patient history and clinical presentation, readings of 12-lead ECG and measurement of cardiac troponins (cTn). Introduction of high-sensitivity cTn assays substantially increases sensitivity to identify patients with acute MI even at the time of presentation to the emergency department at the cost of specificity. However, the proportion of patients presenting with cTn positive, non-vascular cardiac chest pain triples with the implementation of new sensitive cTn assays increasing the difficulty for the emergency physician to identify those patients who are at need for invasive diagnostics. The main objectives of this mini-review are 1) to discuss elements of disposition decision made by the emergency physician for the evaluation of chest pain patients, 2) to summarize recent advances in assay technology and relate these findings into the clinical context, and 3) to discuss possible consequences for the clinical work and suggest an algorithm for the clinical evaluation of chest pain patients in the emergency department.

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Section: Time-dependent Changes Of Troponin Levels In Acute Myocardiasupporting

confidence: 73%

High-sensitivity troponin assays in the evaluation of patients with acute chest pain in the emergency department

Christ

Bertsch

Popp

et al. 2011

Clinical Chemistry and Laboratory Medicine (CCLM)

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show abstract

“…These assays shorten the time to diagnosis by 3 h compared to the use of conventional troponin assays with blood sampling at admission and after 3 and 6 h (2, 3 ). On the other hand, high-sensitivity troponin assays also increase the number of patients presenting with increases in troponin from other causes than MI (4,5 ). Such increases are particularly common in elderly patients (6 ), and lead to reductions in the diagnostic specificity of troponin results.…”

mentioning

confidence: 99%

Troponin T Percentiles from a Random Population Sample, Emergency Room Patients and Patients with Myocardial Infarction

Hammarsten¹,

Fu²,

Sigurjónsdóttir³

et al. 2012

Clinical Chemistry

130

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BACKGROUND:High-sensitivity cardiac troponin T (cTnT) assays detect small clinically important myocardial infarctions (MI) but also yield higher rates of false-positive results owing to increased concentrations sometimes present in patients without MI. Better understanding is needed of factors influencing the 99th percentile of cTnT concentrations across populations and the frequency of changes in cTnT concentrations Ͼ20% often used in combination with increased cTnT concentrations for diagnosis of MI.

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“…Because physician-based subjective calculation of post-test probabilities for an individual patient is prone to errors, 3 diagnostic reasoning in patients with acute coronary syndrome should include formal risk assessment using validated risk assessment tools such as GRACE, TIMI or PURSUIT risk scores. 4 Moreover, the aim of disposition decisions in the ED is not to identify patients with acute MI or risk of death alone, but to identify patients at increased risk for…”

Section: High-sensitivity Troponin Assays and Clinical Decisionsmentioning

confidence: 99%

High-sensitivity troponin assays and clinical decisions

Christ

Bertsch

2012

Ann Clin Biochem

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In their case report, Sami et al. 1 state that very high ferritin concentrations (greater than 10,000 mg/L) have only been described in adult Still's disease, multiple blood transfusions and severe acute hepatocellular damage. It may be of interest to the authors that such marked hyperferritinaemia has also been documented in patients with the human immunodeficiency virus (HIV) complicated by superinfection with a range of opportunistic organisms, particularly disseminated histoplasmosis. 2 We would also like to emphasize that haemophagocytic syndromes, such as haemophagocytic lymphohistiocytosis (HLH), may also produce ferritin concentrations of this magnitude. 3,4 A variety of drugs, infections and rheumatological diseases, including but not exclusively adult Still's disease, may precipitate a haemophagocytic process, 5 or it may be a primary disorder. The diagnosis of HLH relies on the patient satisfying sufficient criteria, of which serum ferritin is a part. 6 As an aside, it appears that haemophagocytosis is associated with lower glycosylation of circulating ferritin, 7 a feature that may extend to other circulation proteins, notably transferrin, 8 possibly due to liver involvement by the pathological process. As an illustrative example, a recent case from our laboratory of a five-year-old girl with HLH secondary to Epstein-Barr virus (EBV) infection demonstrated a serum ferritin concentration of 29,600 mg/L at diagnosis and detectable serum asialotransferrin on isoelectric focusing.A review of all ferritin results greater than 10,000 mg/L from our laboratory network in the past year found 35 results from 30 patients (0.06% of all ferritin requests). Most patients had received multiple transfusions for a variety of reasons (14 cases) or had severe acute hepatocellular damage (9 cases); however, there were four cases of HLH: two adult, both fatal, and two paediatric, both secondary to EBV infection. Three cases of high ferritin were not clearly explained.

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Comparison of high sensitivity and contemporary troponin assays for the early detection of acute myocardial infarction in the emergency department

Cited by 60 publications

References 25 publications

High-sensitivity troponin assays in the evaluation of patients with acute chest pain in the emergency department

High-sensitivity troponin assays in the evaluation of patients with acute chest pain in the emergency department

Troponin T Percentiles from a Random Population Sample, Emergency Room Patients and Patients with Myocardial Infarction

High-sensitivity troponin assays and clinical decisions

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