High-Sensitivity Cardiac Troponin in the Distinction of Acute Myocardial Infarction From Acute Cardiac Noncoronary Artery Disease

Abstract

Background-We hypothesized that high-sensitivity cardiac troponin (hs-cTn) and its early change are useful in distinguishing acute myocardial infarction (AMI) from acute cardiac noncoronary artery disease. Methods and Results-In a prospective, international multicenter study, hs-cTn was measured with 3 assays (hs-cTnT, Roche Diagnostics; hs-cTnI, Beckman-Coulter; hs-cTnI Siemens) in a blinded fashion at presentation and serially thereafter in 887 unselected patients with acute chest pain. Accuracy of the combination of presentation values with serial changes was compared against a final diagnosis adjudicated by 2 independent cardiologists. AMI was the adjudicated final diagnosis in 127 patients (

Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay

“…11 This algorithm is based on 2 concepts. First, high-sensitivity cardiac troponin T is interpreted as a quantitative variable where the proportion of patients who have acute MI increases with increasing concentrations of cardiac troponin T. [6][7][8][9][10][11][12][13][14][15] Second, early absolute changes in the concentrations within 1 hour provide incremental diagnostic information when added to baseline levels, with the combination acting as a reliable surrogate for late concentrations at 3 or 6 hours. [6][7][8][9][10][11][12][13][14][15] However, many experts remained skeptical regarding the safety of the highsensitivity cardiac troponin T 1-hour algorithm and its wider applicability.…”

“…8,11,13,15 Unselected patients presenting to the emergency department with nontraumatic chest pain or other symptoms suggestive of acute MI are enrolled after written, informed consent is obtained. For this analysis, 1714 patients enrolled after the initial pilot study were eligible.…”

“…These patients were enrolled at 6 centres in 3 countries (Switzerland, Spain, Italy) from June 2009 to June 2013. To further increase the generalizability of the findings, the recruitment network was changed as compared with the first phase of the APACE Study: 8,11,13,15 2 new centres were initiated, and 2 centres were closed because the local principal investigators left those centres. The onset or maximum severity of chest pain had to be within the last 12 hours before presentation.…”

“…Major advances have recently been achieved by the development of more sensitive cardiac troponin assays. [6][7][8][9][10][11][12][13][14][15] High-sensitivity cardiac troponin assays, which allow measurement of even low concentrations of cardiac troponin with high precision, have been shown to largely overcome the sensitivity deficit of conventional cardiac troponin assays within the first hours of presentation in the diagnosis of acute MI. [6][7][8][9][10][11][12][13][14][15] These studies have consistently shown that the classic diagnostic interpretation of cardiac troponin as a dichotomous variable (troponinnegative and troponin-positive) no longer seems appropriate, because the positive predictive value for acute MI of being troponin-positive was only about 50%.…”

“…[6][7][8][9][10][11][12][13][14][15] High-sensitivity cardiac troponin assays, which allow measurement of even low concentrations of cardiac troponin with high precision, have been shown to largely overcome the sensitivity deficit of conventional cardiac troponin assays within the first hours of presentation in the diagnosis of acute MI. [6][7][8][9][10][11][12][13][14][15] These studies have consistently shown that the classic diagnostic interpretation of cardiac troponin as a dichotomous variable (troponinnegative and troponin-positive) no longer seems appropriate, because the positive predictive value for acute MI of being troponin-positive was only about 50%. [6][7][8][9][10][11][12][13][14][15] The best way to interpret and Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay Background: We aimed to prospectively valid ate a novel 1hour algorithm using high sensitivity cardiac troponin T measurement for early ruleout and rulein of acute myocardial infarction (MI).…”