Troponin-positive, MB-negative patients with non–ST-elevation myocardial infarction: An undertreated but high-risk patient group: Results from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network–Get With The Guidelines (NCDR ACTION-GWTG) Registry

Kontos, Michael C.; Lemos, James A. de; Ou, Fang Shu; Wiviott, Stephan D.; Foody, JoAnne M.; Newby, L. Kristin; Chen, Anita; Roe, Matthew T.

doi:10.1016/j.ahj.2010.07.022

Cited by 20 publications

(9 citation statements)

References 28 publications

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“…Despite these recommendations, our study shows that the biomarker, particularly troponin level was not routinely measured for patients with AMI in many hospitals with testing capability in 2011. This may hinder diagnosis and risk stratification of patients with NSTEMI, for example, troponin-positive and CK-MB-negative patients have a higher risk profile but are less likely to receive guideline-recommended acute pharmacologic treatment because of the oversight of clinically meaningful early biomarker abnormalities [ 29 ]. Our study suggests that doctors were not selectively avoiding use of biomarker testing according to whether patients presented as STEMI or NSTEMI.…”

Section: Discussionmentioning

confidence: 99%

Trends in Cardiac Biomarker Testing in China for Patients with Acute Myocardial Infarction, 2001 to 2011: China PEACE-Retrospective AMI Study

Zhan¹,

Li²,

Hu³

et al. 2015

PLoS ONE

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ObjectivesTo describe trends in the availability of biomarker testing in Chinese hospitals and how practice complies with established standards for the diagnosis of acute myocardial infarction (AMI).BackgroundCardiac biomarker testing is standard in high-income countries, but little is known about the availability and use of cardiac biomarker testing in low- and middle-income countries (LMICs) such as China.MethodsBased on a nationally representative sample of Chinese hospitals in 2001, 2006 and 2011, we describe the temporal trends and regional differences in the hospital capability and rates of use of cardiac biomarker testing, as well as the variation in use across hospitals with testing capability, for patients labeled with the diagnosis of AMI.ResultsWe sampled 175 hospitals (162 participated in the study) and 18,631 AMI admissions. 14,370 patients were included in analysis of biomarker use. The proportion of hospitals with biomarker testing capability was 57.4% in 2001 (25.0% troponin and 32.4% creatine kinase MB fraction (CK-MB) only) and 96.3% (81.4% troponin and 14.9% CK-MB only) in 2011. The proportion of hospitals with troponin testing capability in 2011 was significantly higher in urban compared with rural hospitals (96.8% vs. 71.4%, p< 0.001). In 2011, only 55.9% of hospitals with troponin testing capability (71 out of 127 hospitals) used the assay for more than 80% of their patients with AMI. Among hospitals with either biomarker testing capability, there was marked variation in use in both rural (from 7.1% to 100.0% of patients) and urban hospitals (from 57.9% to 100.0% of patients). In 2011, 36.1% of the patients with AMI did not have troponin tested and 4.9% did not have either biomarker measured.ConclusionsThe recommended biomarker tests for AMI diagnosis are not universally available and the testing is not consistently applied when it is available in China.Trial RegistrationClinicalTrials.gov NCT01624883

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Section: Discussionmentioning

confidence: 99%

Trends in Cardiac Biomarker Testing in China for Patients with Acute Myocardial Infarction, 2001 to 2011: China PEACE-Retrospective AMI Study

Zhan¹,

Li²,

Hu³

et al. 2015

PLoS ONE

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“…The male/female difference noted for a POC assay (Siemens CS) has not been previously reported in the literature. The lack of sex-defined cutoffs may explain why women have fewer increases in cardiac troponin and may be why women in some studies appear to have different clinical outcomes when they present with acute coronary syndrome (30 ). We strongly advocate for separate 99th percentile values based on sex, regardless of the assay.…”

Section: Discussionmentioning

confidence: 99%

Determination of 19 Cardiac Troponin I and T Assay 99th Percentile Values from a Common Presumably Healthy Population

2012

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“…Moreover, there is evidence that the additional individuals diagnosed by a positive troponin test (ie, those who are troponin positive by creatine kinase–MB negative) actually have a higher risk profile than those who are creatine kinase–MB positive. 41 Furthermore, during this period, the number of AMI hospitalizations actually decreased. 3 …”

Section: Discussionmentioning

confidence: 89%

National trends in stroke after acute myocardial infarction among Medicare patients in the United States: 1999 to 2010

Wang

Lichtman

Dharmarajan

et al. 2015

American Heart Journal

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Background Stroke is a common and important adverse event after acute myocardial infarction (AMI) in the elderly. It is unclear whether the risk of stroke after AMI has changed with improvements in treatments and outcomes for AMI in the last decade. Methods To assess trends in risk of stroke after AMI, we used a national sample of Medicare data to identify Fee-for-Service patients (n = 2,305,441) aged ≥65 years who were discharged alive after hospitalization for AMI from 1999 to 2010. Results We identified 57,848 subsequent hospitalizations for ischemic stroke and 4,412 hospitalizations for hemorrhagic stroke within 1 year after AMI. The 1-year rate of ischemic stroke decreased from 3.4% (95% CI 3.3%-3.4%) to 2.6% (2.5%-2.7%; P < .001). The risk-adjusted annual decline was 3% (hazard ratio, 0.97; [0.97-0.98]) and was similar across all age and sex-race groups. The rate of hemorrhagic stroke remained stable at 0.2% and did not differ by subgroups. The 30-day mortality for patients admitted with ischemic stroke after AMI decreased from 19.9% (18.8%-20.9%) to 18.3% (17.1%-19.6%) and from 48.3% (43.0%-53.6%) to 45.7% (40.3%-51.2%) for those admitted with hemorrhagic stroke. We observed a decrease in 1-year mortality from 37.8% (36.5%-39.1%) to 35.3% (33.8%-36.8%) for ischemic stroke and from 66.6% (61.4%-71.5%) to 60.6% (55.1%-65.9%) for hemorrhagic stroke. Conclusions From 1999 to 2010, the 1-year risk for ischemic stroke after AMI declined, whereas the risk of hemorrhagic stroke remained unchanged. However, 30-day and 1-year mortality continued to be high.

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Troponin-positive, MB-negative patients with non–ST-elevation myocardial infarction: An undertreated but high-risk patient group: Results from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network–Get With The Guidelines (NCDR ACTION-GWTG) Registry

Cited by 20 publications

References 28 publications

Trends in Cardiac Biomarker Testing in China for Patients with Acute Myocardial Infarction, 2001 to 2011: China PEACE-Retrospective AMI Study

Trends in Cardiac Biomarker Testing in China for Patients with Acute Myocardial Infarction, 2001 to 2011: China PEACE-Retrospective AMI Study

Determination of 19 Cardiac Troponin I and T Assay 99th Percentile Values from a Common Presumably Healthy Population

National trends in stroke after acute myocardial infarction among Medicare patients in the United States: 1999 to 2010

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