scholarly journals Single vs Serial Measurements of Cardiac Troponin Level in the Evaluation of Patients in the Emergency Department With Suspected Acute Myocardial Infarction

2021 ◽  
Vol 4 (2) ◽  
pp. e2037930
Author(s):  
Maereg Wassie ◽  
Ming-Sum Lee ◽  
Benjamin C. Sun ◽  
Yi-Lin Wu ◽  
Aileen S. Baecker ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Cardiac Troponin ◽  
Troponin Level ◽  
Serial Measurements ◽  
Suspected Acute Myocardial Infarction

The use of biomarkers for acute cardiovascular disease

2016 ◽  
Author(s):  
Allan S Jaffe
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Positive Predictive Value ◽  
Cardiac Troponin ◽  
Clinical Information ◽  
Clinical Use ◽  
Troponin Level ◽  
Upper Limit ◽  
New Generation

Understanding the proper use of biomarkers requires clinicians to appreciate some critical pre-analytic and analytic issues, as well as how to use the markers properly. The bene?ts of such an approach will not only facilitate the care of patients today, but will also prepare clinicians to understand and embrace the new generation of markers that is coming and that will continue to make this area transformational for cardiology. Two fundamental concepts underlie the clinical use of biomarkers: First, biomarkers should always be used in conjunction with all other clinical information. Second, in order to maximize their diagnostic and prognostic use, biomarkers should be interpreted as quantitative variables. For example, a cardiac troponin level which is 50 times the upper limit of normal has a much higher positive predictive value for the presence of an acute myocardial infarction, compared to a level just above the upper limit of normal.

scholarly journals Health Outcomes Categorized by Current and Previous Definitions of Acute Myocardial Infarction in an Unselected Cohort of Troponin-Naïve Emergency Department Patients

2006 ◽  
Vol 52 (11) ◽  
pp. 2028-2035 ◽  
Author(s):  
Peter A Kavsak ◽  
Andrew R MacRae ◽  
Glenn E Palomaki ◽  
Alice M Newman ◽  
Dennis T Ko ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Health Outcomes ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Survival Rates ◽  
World Health ◽  
Separate Analysis ◽  
Health Organization

Abstract Background: In a population originally classified for acute myocardial infarction (AMI) by the World Health Organization (WHO) definition, we compared the health outcomes after retrospectively reclassifying with the European Society of Cardiology and the American College of Cardiology (ESC/ACC) AMI definition, using the peak cardiac troponin I (cTnI) concentrations. The health outcomes were based on the WHO definition and occurred in an era that preceded the use of cardiac troponin biomarkers. Methods: For 448 patients who presented to the emergency department with symptoms suggestive of cardiac ischemia in 1996, we obtained data for all-cause mortality and recurrent AMI for up to 1 year after the initial presentation. We performed retrospective analysis of the patients’ frozen plasma samples to measure cTnI (AccuTnI®, Beckman Coulter). Results: At 30, 120, and 360 days, the risk for AMI/death in patients positive for AMI by only the ESC/ACC criteria was significantly lower than the risk in patients positive by both ESC/ACC and WHO criteria, and significantly higher than in patients negative according to both criteria. In a separate analysis, patients with a peak cTnI >0.10 μg/L were at greater risk for AMI/death than patients with cTnI concentrations of 0.04–0.10 μg/L. Patients negative by both definitions or with peak cTnI concentrations <0.04 μg/L had the highest event-free survival rates (92% and 94%, respectively) at 1 year. Conclusion: In a troponin-naïve population, patients classified as positive for AMI by only the ESC/ACC criteria have a prognosis that appears to be intermediate between those classified positive by both the WHO and ESC/ACC definitions and those who meet neither criteria.

scholarly journals Predictive value of routine point-of-care cardiac troponin T measurement for prehospital diagnosis and risk-stratification in patients with suspected acute myocardial infarction

2017 ◽  
Vol 8 (4) ◽  
pp. 299-308 ◽  
Author(s):  
Martin B Rasmussen ◽  
Carsten Stengaard ◽  
Jacob T Sørensen ◽  
Ingunn S Riddervold ◽  
Troels M Hansen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Confidence Interval ◽  
Predictive Value ◽  
Cardiac Troponin ◽  
Troponin T ◽  
Point Of Care ◽  
Hazard Ratio ◽  
Cardiac Troponin T ◽  
Suspected Acute Myocardial Infarction

Objective: The purpose of this study was to determine the predictive value of routine prehospital point-of-care cardiac troponin T measurement for diagnosis and risk stratification of patients with suspected acute myocardial infarction. Methods and results: All prehospital emergency medical service vehicles in the Central Denmark Region were equipped with a point-of-care cardiac troponin T device (Roche Cobas h232) for routine use in all patients with a suspected acute myocardial infarction. During the study period, 1 June 2012–30 November 2015, prehospital point-of-care cardiac troponin T measurements were performed in a total of 19,615 cases seen by the emergency medical service and 18,712 point-of-care cardiac troponin T measurements in 15,781 individuals were matched with an admission. A final diagnosis of acute myocardial infarction was confirmed in 2187 cases and a total of 2150 point-of-care cardiac troponin T measurements (11.0%) had a value ≥50 ng/l, including 966 with acute myocardial infarction (sensitivity: 44.2%, specificity: 92.8%). Patients presenting with a prehospital point-of-care cardiac troponin T value ≥50 ng/l had a one-year mortality of 24% compared with 4.8% in those with values <50 ng/l, log-rank: p<0.001. The following variables showed the strongest association with mortality in multivariable analysis: point-of-care cardiac troponin T≥50 ng/l (hazard ratio 2.10, 95% confidence interval: 1.90–2.33), congestive heart failure (hazard ratio 1.93, 95% confidence interval: 1.74–2.14), diabetes mellitus (hazard ratio 1.42, 95% confidence interval: 1.27–1.59) and age, one-year increase (hazard ratio 1.08, 95% confidence interval: 1.08–1.09). Conclusions: Patients with suspected acute myocardial infarction and a prehospital point-of-care cardiac troponin T ≥50 ng/l have a poor prognosis irrespective of the final diagnosis. Routine troponin measurement in the prehospital setting has a high predictive value and can be used to identify high-risk patients even before hospital arrival so that they may be re-routed directly for advanced care at an invasive centre.

Sign in / Sign up

Export Citation Format

Share Document