Delta troponin for the early diagnosis of AMI in emergency patients with chest pain

Cullen, Louise; Parsonage, William; Greenslade, Jaimi; Lamanna, Arvin; Hammett, C.; Than, Martin; Tate, Jillian R.; Kalinowski, Lauren; Ungerer, Jacobus P.J.; Chu, Kevin; Brown, Anthony

doi:10.1016/j.ijcard.2013.03.044

Cited by 44 publications

(31 citation statements)

References 30 publications

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“…p-Values are shown for each characteristic; p-values for sex, race, and TIMI risk score represent the relationship between diagnosis and all levels of the characteristic. These findings support recent reports suggesting that the majority of patients with MI can be identified at earlier observation times [8][9][10][11][12][13][14][15][16][17]. Our study reinforces the consensus recommendations [18,19] for optimal blood sampling at admission and 3 h later.…”

Section: Discussionsupporting

confidence: 92%

Diagnostic performance of cardiac Troponin I for early rule-in and rule-out of acute myocardial infarction: Results of a prospective multicenter trial

Storrow

Christenson

Nowak

et al. 2015

Clinical Biochemistry

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Section: Discussionsupporting

confidence: 92%

Diagnostic performance of cardiac Troponin I for early rule-in and rule-out of acute myocardial infarction: Results of a prospective multicenter trial

Storrow

Christenson

Nowak

et al. 2015

Clinical Biochemistry

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“…2,3 The improved analytical precision of cTn in conjunction with serial measurements has raised interest in the utility of cTn concentration changes over time (delta, δ). [9][10][11][12][13][14][15][16] The role of serial cTn changes has been studied primarily to distinguish between acute and chronic cardiac injury. However, the role for delta cTn to distinguish type 1 and 2 MI is unclear, and further investigation is needed.…”

Section: Introductionmentioning

confidence: 99%

Cardiac troponin changes to distinguish type 1 and type 2 myocardial infarction and 180-day mortality risk

Sandoval

Thordsen

Smith

et al. 2014

European Heart Journal: Acute Cardiovascular Care

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Section: This Issue Of Clinical Chemistry and Laboratory Medicinementioning

confidence: 99%

“…With the novel hs-cTn assays it is possible to reliably determine Δ-cTn even below the 99th percentile. However, the meaning of such changes is not clear and we will need more data from dedicated studies to interpret them [8][9][10].In order to better appreciate these problems, it is helpful to remember the reasons for the new definition of myocardial infarction introduced in the year 2000 [11]. In the past we tended to differentiate between stable angina, unstable angina, and myocardial infarction.…”

mentioning

confidence: 99%

High-sensitivity assays for cardiac troponins

Lackner

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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(CCLM) devotes a large section to the cardiac troponins (cTn) and in particular to the impact of the novel high sensitivity (hs) assays on clinical practice. Furthermore, several articles deal with known or novel pitfalls of hs-cTn in clinical diagnostics.While there is no doubt that the hs-cTn assays constitute a significant analytical step forward, they obviously introduced a momentum of uncertainty for many clinicians. Perhaps this is common to all innovations which force people to leave their well known firm ground. In the case of hs-Tn the major changes relate to the rule-in and rule-out criteria of myocardial infarction. Already the first studies have provided robust data that early rule-out can be substantially improved and the ESC has adapted their guidelines accordingly [1][2][3]. However, many clinicians feel that rule-in has become more complicated not to say confusing. Since many of the traditional cTn assays had cut-offs far beyond the 99th percentile due to their relatively high limit of quantitation (LoQ) [4], the positive predictive value of an abnormal test result was high. In fact, it is important to keep in mind that the upper reference limit (URL) of most assays was not the 99th percentile but a significantly higher plasma concentration of cTn [4]. The novel hs-cTn assays provide reliable results between their 99th percentile and the cut-off of their predecessor tests [5]. This opens up a gray zone which was neglected in the past. Interpretation and clinical consequences derived from hs-cTn results in this gray zone are currently debated. For some but not all assays we have thorough data about positive and negative predictive values depending on individual patient characteristics and timing of cTn plasma concentrations [6]. Another issue that is profoundly influenced by the hs-cTn assays is the analysis of changes in cTn plasma concentrations over time and their diagnostic potential [7]. Many traditional cTn assays were not able to provide reliable time courses close to the 99th percentile. Therefore, the use of Δ-cTn generated with these assays was very limited. With the novel hs-cTn assays it is possible to reliably determine Δ-cTn even below the 99th percentile. However, the meaning of such changes is not clear and we will need more data from dedicated studies to interpret them [8][9][10].In order to better appreciate these problems, it is helpful to remember the reasons for the new definition of myocardial infarction introduced in the year 2000 [11]. In the past we tended to differentiate between stable angina, unstable angina, and myocardial infarction. In the 1990s it became clear that patients with unstable angina with elevated cTn concentration had the same risk of adverse outcomes as patients with what was then considered myocardial infarction, while patients without cTn elevations had a much better prognosis [12]. Interestingly, this subgroup of unstable angina patients also benefited from the same interventions as patients with myocardial infarction [13]. This observation finally l...

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Delta troponin for the early diagnosis of AMI in emergency patients with chest pain

Cited by 44 publications

References 30 publications

Diagnostic performance of cardiac Troponin I for early rule-in and rule-out of acute myocardial infarction: Results of a prospective multicenter trial

Diagnostic performance of cardiac Troponin I for early rule-in and rule-out of acute myocardial infarction: Results of a prospective multicenter trial

Cardiac troponin changes to distinguish type 1 and type 2 myocardial infarction and 180-day mortality risk

High-sensitivity assays for cardiac troponins

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