No additional value of conventional and high-sensitivity cardiac troponin over clinical scoring systems in the differential diagnosis of type 1 vs. type 2 myocardial infarction

Abstract

The diagnostic information provided by serial measurements of conventional or hs-cTnT is not better than that yielded by a simple clinical scoring model. Absolute changes are more informative than relative troponin changes.

Diagnostic features, management and prognosis of type 2 myocardial infarction compared to type 1 myocardial infarction: a systematic review and meta-analysis

“…A total of 40 studies were included for analysis13–52 and their characteristics are summarised in online supplemental table S3. They comprised a total of 127 620 participants of whom 98 930 participants (77.5%) were classified as T1MI and 13 803 (10.8%) as T2MI.…”

“…The 2007 definition1 was used in 7 (17.5%) studies,15 16 27 29 43 44 52 the 2012 definition2 in 25 (62.5%) studies,13 17 19–21 23–26 30–35 37 39 40 42 45–48 50 51 and the 2018 definition3 in 8 (20%) studies 14 18 22 28 36 38 41 49. Of the 40 studies, 17 (42.5%) were prospective15 16 18 19 22 29 33 34 36 37 43–45 47 48 50 51and 23 (57.5%) were retrospective 13 14 17 20 21 23–28 30–32 35 38–42 46 49 52…”

“…Of the 40 studies, 31 (77.5%) were assessed as good quality,13 15–19 22 23 27–35 37–46 48 50–52 6 (15%) as fair quality,14 21 24–26 49and 3 (7.5%) as poor quality,20 36 47 as summarised in online supplemental table S4. Selection bias resulting in unrepresentative cohorts such as admission criteria to coronary care units or entry criteria into MI registries favouring T1MI,14 20 24–26 36 47 49 absence of independent adjudication of MI type as T1MI or T2MI,36 38 47 non-comparability of T1MI and T2MI cohorts,20 24 25 47 poorly specified outcome measures36 38 47 and short follow-up period resulting in few events14 20 24 36 comprised most forms of bias.…”

“… 8 In our review, this excess mortality was not driven by an excess of cardiovascular deaths, and likely reflects the competing risks of multiple comorbidities, rather than underlying obstructive coronary artery disease which was seen in 30%–50% of patients with T2MI. 26 31 Studies yielded mixed results as to whether coronary artery disease is an independent predictor of T2MI, 20 42 while others question the angiographic distinction between T2MI and T1MI. For example, in a study of 450 consecutive patients with MI who all underwent coronary angiography within 24 hours of symptom onset, 145 (32.2%) patients had ‘true’ T1MI (acute atherothrombosis and no systemic triggers), 114 (25.3%) had ‘true’ T2MI (no atherothrombosis and systemic triggers), 61 (13.6%) patients had neither, and 130 (28.9%) patients had both.…”

Type 1 or Type 2 Myocardial Infarction in Patients with a History of Coronary Artery Disease: Data from the Emergency Department

“…With a cut-off of 17.5 × 10 3 , we found that the CRP/troponin ratio had a specificity of 90% for T2MI versus T1MI, which could help the choice of not performing immediate PCI. Troponin has already been highlighted as a useful biomarker for the distinction between T1MI and T2MI in patients presenting to the ED, especially when considering the delta of concentrations at admission and after 4 h [24,25], but when considered alone, poorly discriminates T2MI from TIMI [26]. Nowak et al assessed the predictive value of N-terminal-pro brain natriuretic peptide (NT-Pro BNP)/troponin ratio for the differentiation of 25 T1MI cases from 18 T2MI cases in the ED [27].…”