Early Diagnosis of Myocardial Infarction Using Absolute and Relative Changes in Cardiac Troponin Concentrations

Irfan, Affan; Reichlin, Tobias; Twerenbold, Raphael; Meister, Marc; Moehring, Berit; Wildi, Karin; Bassetti, Stefano; Zellweger, Christa; Giménez, María Rubini; Hoeller, Rebeca; Murray, Karsten; Sou, Seoung Mann; Mueller, Mira; Mosimann, Tamina; Reiter, Miriam; Haaf, Philip; Ziller, Ronny; Freidank, Heike; Oßwald, Stefan; Müeller, Christian

doi:10.1016/j.amjmed.2013.02.031

Cited by 43 publications

(27 citation statements)

References 25 publications

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“…Accordingly, prevalence of hs-cTnT exceeding the 99th percentile was only 9%-15% in studies that restricted inclusion to chest pain (9 ) as opposed to 51.2% (7 ), 63% (20 ), and 65.8% (21 ) reported in studies including patients with a broader range of symptoms. Conversely, rates of patients with increased cardiac troponin due to non-ACS conditions were considerably lower in studies enrolling exclusively patients with chest pain (1,2,5,6 ) compared to studies with more comprehensive enrollment criteria (9,20,21,22 ). In confirmation of these findings, patients presenting with dyspnea had the highest hs-cTnT concentrations and were more often diagnosed with non-ACS conditions in our study.…”

Section: Discussionsupporting

confidence: 80%

“…Major tasks in an emergency department (ED) are not only to rule out AMI accurately but also to discriminate non-ST segment elevation myocardial infarction (STEMI) from non-ACS-related conditions, particularly among those who present with an increased cardiac troponin result. Performance measures of baseline and serial cardiac troponin measurements for the diagnosis of AMI using sensitive and hs-cardiac troponin assays range from excellent, with areas under the curve (AUCs) between 0.92 and 0.96 (1, 4 -6 ), to moderate, with AUCs as low as 0.73 (7 ), even with the use of the same hs-cTnT assay (1,5,7 ), indicating a potential influence of the study cohort.…”

confidence: 99%

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Impact of Leading Presenting Symptoms on the Diagnostic Performance of High-Sensitivity Cardiac Troponin T and on Outcomes in Patients with Suspected Acute Coronary Syndrome

et al. 2015

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Section: Discussionsupporting

confidence: 80%

confidence: 99%

Impact of Leading Presenting Symptoms on the Diagnostic Performance of High-Sensitivity Cardiac Troponin T and on Outcomes in Patients with Suspected Acute Coronary Syndrome

et al. 2015

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“…28 In a study of the absolute and relative changes in troponin levels at presentation and after 1 and 2 hours, absolute changes measured using the highsensitivity troponin T assay had significantly greater diagnostic accuracy than relative changes. 29 Despite the increased sensitivity of this assay at presentation, guideline committees have been reluctant to endorse its use to rule out acute MI based on a single value. In an investigation of an algorithm designed to expedite discharge of patients presenting to the emergency department with chest pain, acute MI was ruled out among patients with troponin T below 12 ng/L at presentation and a change of less than 3 ng/L over the first hour based on the sensitive assay.…”

Section: Cmaj Openmentioning

confidence: 99%

Performance of the high-sensitivity troponin assay in diagnosing acute myocardial infarction: systematic review and meta-analysis

et al. 2014

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Background: High-sensitivity cardiac troponin assays have been adopted by many clinical centres worldwide; however, clinicians are uncertain how to interpret the results. We sought to assess the utility of these assays in diagnosing acute myocardial infarction (MI). Methods:We carried out a systematic review and meta-analysis of studies comparing high-sensitivity with conventional assays of cardiac troponin levels among adults with suspected acute MI in the emergency department. We searched MEDLINE, EMBASE and Cochrane databases up to April 2013 and used bivariable random-effects modelling to obtain summary parameters for diagnostic accuracy. Results:We identified 9 studies that assessed the use of high-sensitivity troponin T assays (n = 9186 patients). The summary sensitivity of these tests in diagnosing acute MI at presentation to the emergency department was estimated to be 0.94 (95% confidence interval [CI] 0.89-0.97); for conventional tests, it was 0.72 (95% CI 0.63-0.79). The summary specificity was 0.73 (95% CI 0.64-0.81) for the high-sensitivity assay compared with 0.95 (95% CI 0.93-0.97) for the conventional assay. The differences in estimates of the summary sensitivity and specificity between the high-sensitivity and conventional assays were statistically significant (p < 0.01). The area under the curve was similar for both tests carried out 3-6 hours after presentation. Three studies assessed the use of high-sensitivity troponin I assays and showed similar results.Interpretation: Used at presentation to the emergency department, the high-sensitivity cardiac troponin assay has improved sensitivity, but reduced specificity, compared with the conventional troponin assay. With repeated measurements over 6 hours, the area under the curve is similar for both tests, indicating that the major advantage of the high-sensitivity test is early diagnosis. Abstract

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“…Other possible mechanisms of elevation of troponin would be coronary hypo perfusion secondary to low cardiac output and elevation of intracavitary pressures, with consequent reduction of coronary perfusion pressure. Troponin I is also elevated in a large percentage of patients with acute heart failure without acute coronary obstructions and in some studies, has been shown to be an independent predictor of mortality [72]. Another application of troponin I is in the diagnosis of trauma and suspicion of traumatic cardiac contusion without the false positives presented when using CK-MB for this purpose.…”

Section: Myocardial Markersmentioning

confidence: 99%

The Recent Advances in the Serological Detection of Acute Myocardial Infarction

Gh¹,

Ac²

2016

Clin Med Biochemistry

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Acute Myocardial Infarction (AMI) is one of the leading causes of morbidity and mortality worldwide. The greatest risk of fatality occurs within the first hours of initiation of AMI. Thus, the early diagnosis of cardiac ischemia is fundamental for the effective management of AMI patients. Inadequate diagnosis of patients with chest pain often leads to inadequate admission of patients without AMI and vice versa. In addition to the clinical history, physical examination, accurate electrocardiogram findings, and evaluation of cardiac biomarkers play an important role in the early diagnosis of acute ischemia. The present review discusses in detail the various cardiac biomarkers released during the event of an AMI.

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Early Diagnosis of Myocardial Infarction Using Absolute and Relative Changes in Cardiac Troponin Concentrations

Cited by 43 publications

References 25 publications

Impact of Leading Presenting Symptoms on the Diagnostic Performance of High-Sensitivity Cardiac Troponin T and on Outcomes in Patients with Suspected Acute Coronary Syndrome

Impact of Leading Presenting Symptoms on the Diagnostic Performance of High-Sensitivity Cardiac Troponin T and on Outcomes in Patients with Suspected Acute Coronary Syndrome

Performance of the high-sensitivity troponin assay in diagnosing acute myocardial infarction: systematic review and meta-analysis

The Recent Advances in the Serological Detection of Acute Myocardial Infarction

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