Document Detail


High-sensitivity cardiac troponin in the distinction of acute myocardial infarction from acute cardiac noncoronary artery disease.
MedLine Citation:
PMID:  22623715     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 (15%); cardiac noncoronary artery disease, in 124 (14%). Patients with AMI had higher median presentation values of hs-cTnT (0.113 μg/L [interquartile range, 0.049-0.246 μg/L] versus 0.012 μg/L [interquartile range, 0.006-0.034 μg/L]; P<0.001) and higher absolute changes in hs-cTnT in the first hour (0.019 μg/L [interquartile range, 0.007-0.067 μg/L] versus 0.001 μg/L [interquartile range, 0-0.003 μg/L]; P<0.001) than patients with cardiac noncoronary artery disease. Similar findings were obtained with the hs-cTnI assays. Adding changes of hs-cTn in the first hour to its presentation value yielded a diagnostic accuracy for AMI as quantified by the area under the receiver-operating characteristics curve of 0.94 for hs-cTnT (0.92 for both hs-cTnI assays). Algorithms using ST-elevation, presentation values, and changes in hs-cTn in the first hour accurately separated patients with AMI and those with cardiac noncoronary artery disease. These findings were confirmed when the final diagnosis was readjudicated with the use of hs-cTnT values and validated in an independent validation cohort.
CONCLUSION: The combined use of hs-cTn at presentation and its early absolute change excellently discriminates between patients with AMI and those with cardiac noncoronary artery disease.
CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00470587.
Authors:
Philip Haaf; Beatrice Drexler; Tobias Reichlin; Raphael Twerenbold; Miriam Reiter; Julia Meissner; Nora Schaub; Claudia Stelzig; Michael Freese; Amely Heinzelmann; Christophe Meune; Cathrin Balmelli; Heike Freidank; Katrin Winkler; Kris Denhaerynck; Willibald Hochholzer; Stefan Osswald; Christian Mueller
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2012-05-23
Journal Detail:
Title:  Circulation     Volume:  126     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-07-03     Completed Date:  2012-09-17     Revised Date:  2013-03-01    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  31-40     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00470587
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Aged, 80 and over
Biological Markers / blood
Coronary Artery Disease / blood*,  diagnosis*
Female
Humans
Male
Middle Aged
Myocardial Infarction / blood*,  diagnosis*
Prospective Studies
Retrospective Studies
Single-Blind Method
Troponin T / blood*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Troponin T
Comments/Corrections
Comment In:
Circulation. 2013 Jan 22;127(3):e355-6
Circulation. 2013 Jan 22;127(3):e354   [PMID:  23339099 ]
Circulation. 2013 Jan 22;127(3):e353   [PMID:  23339098 ]

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