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Sensitive Troponin Assay and the Classification of Myocardial Infarction.
MedLine Citation:
PMID:  25436428     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Lowering the diagnostic threshold for troponin is controversial because it may disproportionately increase the diagnosis of myocardial infarction in patients without acute coronary syndrome. We assessed the impact of lowering the diagnostic threshold of troponin on the incidence, management and outcome of patients with type 2 myocardial infarction or myocardial injury.
METHODS: Consecutive patients with elevated plasma troponin I concentrations (≥50 ng/L; n=2,929) were classified as type 1 (50%) myocardial infarction, type 2 myocardial infarction or myocardial injury (48%) and type 3-5 myocardial infarction (2%) before and after lowering the diagnostic threshold from 200 to 50 ng/L with a sensitive assay. Event-free survival from death and recurrent myocardial infarction was recorded at one year.
RESULTS: Lowering the threshold increased the diagnosis of type 2 myocardial infarction or myocardial injury more than type 1 myocardial infarction (672 versus 257 additional patients, P<0.001). Patients with myocardial injury or type 2 myocardial infarction were at higher risk of death compared to type 1 myocardial infarction (37% versus 16%; RR 2.31, 95%CI 1.98-2.69), but had fewer recurrent myocardial infarctions (4% versus 12%; RR 0.35, 0.26-0.49). In patients with troponin concentrations 50-199 ng/L, lowering the diagnostic threshold was associated with increased healthcare resource utilization (P<0.05) that reduced recurrent myocardial infarction and death for patients with type 1 myocardial infarction (31% versus 20%; RR 0.64, 0.41-0.99), but not type 2 myocardial infarction or myocardial injury (36% versus 33%; RR 0.93, 0.75-1.15).
CONCLUSION: Following implementation of a sensitive troponin assay, the incidence of type 2 myocardial infarction or myocardial injury disproportionately increased and is now as frequent as type 1 myocardial infarction. Outcomes of patients with type 2 myocardial infarction or myocardial injury are poor and do not appear to be modifiable following reclassification despite substantial increases in healthcare resource utilization.
Authors:
Anoop Sv Shah; David A McAllister; Rosamund Mills; Kuan Ken Lee; Antonia Md Churchhouse; Kathryn M Fleming; Elizabeth Layden; Atul Anand; Omar Fersia; Nikhil V Joshi; Simon Walker; Allan S Jaffe; Keith Aa Fox; David E Newby; Nicholas L Mills
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-28
Journal Detail:
Title:  The American journal of medicine     Volume:  -     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-12-1     Completed Date:  -     Revised Date:  2014-12-2    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
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