Early diagnosis of acute myocardial infarction in patients with mild elevations of cardiac troponin

Boeddinghaus, Jasper; Reichlin, Tobias; Nestelberger, Thomas; Twerenbold, Raphael; Meili, Yvette; Wildi, Karin; Hillinger, Petra; Giménez, María Rubini; Cupa, Janosch; Schumacher, Lukas; Schubera, Marie; Badertscher, Patrick; Corbière, Sydney; Grimm, Karin; Puelacher, Christian; Sabti, Zaid; Flores, Dayana; Schaerli, Nicolas; Kozhuharov, Nikola; Shrestha, Samyut; Bürge, Tobias; Mächler, Patrick; Büchi, Michael; Rentsch, Katharina; Miró, Òscar; López, Beatriz; Martín‐Sánchez, Francisco Javier; Rodríguez‐Adrada, Esther; Morawiec, Beata; Kawecki, Damian; Ganovská, Eva; Pařenica, Jiří; Lohrmann, Jens; Buser, Andreas; Keller, Dagmar I.; Oßwald, Stefan

doi:10.1007/s00392-016-1075-9

Cited by 41 publications

(27 citation statements)

References 49 publications

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“…Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) is an ongoing prospective international multicenter study designed to advance the early diagnosis of AMI (ClinicalTrials.gov registry, number NCT00470587) (Reichlin et al., , , ; Boeddinghaus et al., , ). Unselected patients presenting to the ED with symptoms suggestive of AMI (such as acute chest discomfort and angina pectoris) with an onset or peak within the last 12 hr and an age >18 were recruited.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic value of the cardiac electrical biomarker, a novel ECG marker indicating myocardial injury, in patients with symptoms suggestive of non‐ST‐elevation myocardial infarction

Strebel

Twerenbold

Boeddinghaus

et al. 2018

Noninvasive Electrocardiol

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Section: Methodsmentioning

confidence: 99%

Diagnostic value of the cardiac electrical biomarker, a novel ECG marker indicating myocardial injury, in patients with symptoms suggestive of non‐ST‐elevation myocardial infarction

Strebel

Twerenbold

Boeddinghaus

et al. 2018

Noninvasive Electrocardiol

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“…For rapid rule-out in AMI patients with hs-cTn, two alternative approaches using the 0 h/1 h algorithm or 0 h/3 h algorithm have been adequately validated and may be considered [20]. It has been confirmed that the addition of the 1h-hs-cTn measurement significantly promotes the diagnostic accuracy in the patients with mild cTn elevation [27]. e ESC recommended that the rule-in using the 0 h/3 h algorithm has a high positive predictive value, while the sensitivity remains too low for clinical use [28].…”

Section: Cardiac Troponinmentioning

confidence: 99%

The Biomarkers for Acute Myocardial Infarction and Heart Failure

Wang

Zhang

et al. 2020

BioMed Research International

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The use of a large number of cardiovascular biomarkers, meant to complement the use of the electrocardiogram, echocardiography cardiac imaging, and clinical symptom assessment, has become a routine in clinical diagnosis, differential diagnosis, risk stratification, and prognosis and guides the management of patients with suspected cardiovascular diseases. There is a broad consensus that cardiac troponin and natriuretic peptides are the preferred biomarkers in clinical practice for the diagnosis of the acute coronary syndrome and heart failure, respectively, while the roles and possible clinical applications of several other potential biomarkers are still under study. This review mainly focuses on the recent studies of the roles and clinical applications of troponin and natriuretic peptides, which seem to be the best-validated markers in distinguishing and predicting the future cardiac events of patients with suspected cardiovascular diseases. Additionally, the review briefly discusses some of the large number of potential markers that may play a more prominent role in the future.

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“…Subsequently, we analyzed different subgroups: patients hospitalized in the cardiology department (Subgroup 1), patients hospitalized in other departments (Subgroup 2), and lastly, to investigate the findings in a cohort of patients with high a priori probability for the diagnosis of acute myocardial infarction (Subgroup 3), we applied clinically relevant laboratory criteria to all inpatients of the cardiology department in a separate analysis: with high-sensitivity troponin testing based on the ESC hs-TnT 0/1h algorithm [7,8,24,25] and regarding patients with conventional troponin testing with markedly elevated cTnI values (i.e., 5 times the normal upper limit) or a 50% dynamic change between two serial measurements.…”

Section: Study Populationmentioning

confidence: 99%

High-Sensitivity Troponin T Testing: Consequences on Daily Clinical Practice and Effects on Diagnosis of Myocardial Infarction

Zachoval

Dolscheid‐Pommerich

Graeff

et al. 2020

JCM

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It remains unclear how introduction of high-sensitivity troponin T testing, as opposed to conventional troponin testing, has affected the diagnosis of acute myocardial infarction (AMI) and resource utilization in unselected hospitalized patients. In this retrospective analysis, we include all consecutive cases from our center during two corresponding time frames (10/2016–04/2017 and 10/2017–04/2018) for which different troponin tests were performed: conventional troponin I (cTnI) and high-sensitivity troponin T (hs-TnT) assays. Testing was performed in 18,025 cases. The incidence of troponin levels above the 99th percentile was significantly higher in cases tested using hs-TnT. This was not associated with increased utilization of echocardiography, coronary angiography, or percutaneous coronary intervention. Although there were no changes in local standard operating procedures, study site personnel, or national coding guidelines, the number of coded AMI significantly decreased after introduction of hs-TnT. In this single-center retrospective study comprising 18,025 mixed medical and surgical cases with troponin testing, the introduction of hs-TnT was not associated with changes in resource utilization among the general cohort, but instead, led to a decrease in the international classification of diseases (ICD)-10 coded diagnosis of AMI.

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Early diagnosis of acute myocardial infarction in patients with mild elevations of cardiac troponin

Abstract: About 6-22% of patients presenting with suggestive AMI to the ED have mild hs-cTnT/I elevations at presentation. In contrast to copeptin, the addition of 1h-hs-cTn changes substantially improves the early diagnosis of AMI.

Cited by 41 publications

References 49 publications

Diagnostic value of the cardiac electrical biomarker, a novel ECG marker indicating myocardial injury, in patients with symptoms suggestive of non‐ST‐elevation myocardial infarction

Diagnostic value of the cardiac electrical biomarker, a novel ECG marker indicating myocardial injury, in patients with symptoms suggestive of non‐ST‐elevation myocardial infarction

The Biomarkers for Acute Myocardial Infarction and Heart Failure

High-Sensitivity Troponin T Testing: Consequences on Daily Clinical Practice and Effects on Diagnosis of Myocardial Infarction

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