Universal definition of MI: Above 99 percentile of upper reference limit (URL) for hs-cTn: Yes, but which URL?

2019 ◽  
Vol 37 (3) ◽  
pp. 510 ◽  
Author(s):  
Mehmet Agirbasli
Keyword(s):  
Reference Limit ◽  
Universal Definition ◽  
Definition Of ◽  
Upper Reference Limit

The universal definition of myocardial infarction

2015 ◽  
Author(s):  
Kristian Thygesen ◽  
Joseph S Alpert ◽  
Allan S Jaffe ◽  
Harvey D White
Keyword(s):  
Myocardial Infarction ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Cardiac Biomarkers ◽  
Regional Wall ◽  
Reference Limit ◽  
Electrocardiographic Changes ◽  
Universal Definition ◽  
Definition Of ◽  
Upper Reference Limit

Myocardial infarction is defined pathologically as myocyte necrosis due to prolonged ischaemia. These conditions are met when there is a detection of a rise and/or fall of cardiac biomarkers, preferably troponins, with at least one value above the 99th percentile of the upper reference limit, together with evidence of myocardial ischaemia, as recognized by at least one of the following: symptoms of ischaemia, electrocardiographic changes of new ischaemia, the development of pathological Q waves, imaging evidence of a new loss of viable myocardium or new regional wall motion abnormality, or the identification of an intracoronary thrombus by angiography or autopsy.

The universal definition of myocardial infarction

2021 ◽  
pp. 463-478
Author(s):  
Kristian Thygesen ◽  
Joseph S Alpert ◽  
Allan S Jaffe ◽  
Harvey D White
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Ischaemia ◽  
Regional Wall Motion ◽  
Cardiac Biomarkers ◽  
Regional Wall ◽  
Reference Limit ◽  
Universal Definition ◽  
Definition Of ◽  
Upper Reference Limit ◽  
Cardiac Troponins

Myocardial infarction is defined by the presence of myocardial injury detected by abnormal cardiac biomarkers in the setting of acute clinical myocardial ischaemia. These conditions are met when there is a detection of a rise and/or fall of cardiac biomarkers, preferably cardiac troponins, with at least one value above the 99th percentile of the upper reference limit together with evidence of acute clinical myocardial ischaemia as recognized by at least one of the following: symptoms of ischaemia, ECG changes of new ischaemia, development of pathological Q waves, imaging evidence of new loss of viable myocardium or new regional wall motion abnormality, or identification of an intracoronary thrombus by angiography or autopsy.

scholarly journals Definition of the upper reference limit of glycated albumin in blood donors from Italy

2017 ◽  
Vol 56 (1) ◽  
Author(s):  
Chiara Bellia ◽  
Martina Zaninotto ◽  
Chiara Cosma ◽  
Luisa Agnello ◽  
Bruna Lo Sasso ◽  
...  
Keyword(s):  
Blood Donors ◽  
Glycated Albumin ◽  
Specific Reference ◽  
Reference Limit ◽  
Percentile Method ◽  
The Mean ◽  
Definition Of ◽  
Upper Reference Limit ◽  
Mean Glucose

AbstractBackground:Glycated Albumin (GA) has been proposed as a short-term indicator of glycemic homeostasis. The aim of this study is to describe the distribution of GA in a large sample of blood donors from Italy to evaluate whether demographic features, namely age and sex, could influence GA levels and define specific reference limits.Methods:The study included 1334 Italian blood donors. GA was measured using an enzymatic method (quantILab Glycated Albumin, IL Werfen, Germany). The upper reference limit (URL) was calculated using the non-parametric percentile method.Results:A modest, although significant, increase of GA was observed in relation to age (p<0.001), especially in males, where the differences were more pronounced (p<0.001 in males, p=0.003 in females). Slight differences were documented based on sex (12% [11.3–12.8] in males; 12.2% [11.4–13.1] in females; p=0.01). After excluding individuals with fasting plasma glucose ≥7 mmol/L, the calculated GA URL was 14.5% (95% CI: 14.3–14.7). Subjects with GA>14.5% presented a mean age of 48.4±12.2 years, 66.7% were males and the mean glucose was 6.88±2.5 mmol/L.Conclusions:GA in Caucasians shows a similar increasing trend at older ages documented in other ethnicities. The definition of the URL in this population could be useful for both clinical studies, which will clarify the role of GA for diagnosing and monitoring diabetes, and will encourage the introduction of GA in clinical practice.

Emergency department triage of patients with acute chest pain: definition of cardiac troponin I decisional value to manage patients without electrocardiographic evidence of ischemia

2004 ◽  
Vol 42 (5) ◽  
Author(s):  
Pascale Beyne ◽  
Erik Bouvier ◽  
Patrick Werner ◽  
Pierre Bourgoin ◽  
Damien Logeart ◽  
...  
Keyword(s):  
Chest Pain ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Acute Chest Pain ◽  
Final Diagnosis ◽  
Cardiac Troponin I ◽  
Reference Limit ◽  
Coronary Syndrome ◽  
Definition Of ◽  
Upper Reference Limit

AbstractThe aim of this study was to define the use of a new cardiac troponin I (cTnI) assay for emergency patients with chest pain and no specific electrocardiographic changes consistent with the presence of ischemia. Patients (n=106) admitted in Emergency/Cardiology Departments for chest pain and suspicion of acute coronary syndrome (ACS) were randomized into two diagnosis groups (ACS or non-ACS) by two independent cardiologists. cTnI measurements were performed at admission, and 6 hours and 12 hours later with a new generation assay (Access AccuTnI, Beckman Coulter). Using an upper reference limit of 0.04 μg/l, 27 patients had a cTnI elevation not related to the final diagnosis of ischemia; the positive predictive value (PPV) was 67% with specificity 48%. The decisional value was re-defined and set at 0.16 μg/l, a concentration corresponding to the 99th percentile of the non-ACS patient group. Precision (coefficient of variation) was 8% at this level, PPV 97% and specificity 98%. This new decisional value is now used in our institution and could be included in standard care guidelines to improve the management of patients presenting chest pain in emergency departments.

Where does subclinical hypothyroidism start?

2005 ◽  
Vol 44 (02) ◽  
pp. 56-61 ◽  
Author(s):  
G. Wunderlich ◽  
Th. Grüning ◽  
R. Koch ◽  
H. Döge ◽  
J. Kotzerke ◽  
...  
Keyword(s):  
Reference Range ◽  
Clinical Biochemistry ◽  
Reference Group ◽  
Reference Population ◽  
Total Study Population ◽  
Autoimmune Thyroid ◽  
Reference Limit ◽  
Study Population ◽  
Definition Of ◽  
Upper Reference Limit

SummaryThe upper limit of the TSH reference range is currently under discussion. In its recent guidelines, the National Academy of Clinical Biochemistry (NACB) recommended the use of ~2.5 mIU/L, rather than ~4 mIU/L, due to the fact that reference populations, on which the definition of the reference range is based, contain persons undergoing an initial phase of autoimmune thyroid disease. This will skew the upper reference limit of TSH. Ultrasonography, in addition to measurement of thyroid autoantibodies, should be used to exclude these persons. Objective: The present study investigates whether the NACB recommendation also applies for a region of mild iodine deficiency. Methods: According to NACB criteria, a reference population (713 persons) was defined out of a total study population of 1442. The TSH reference range was calculated in this reference group and in further subgroups by percentiles. The results were compared with the total study population and the NACB recommendation. All assays used were provided by BRAHMS Diagnostica AG, Hennigsdorf, Germany. Results: As expected, all median TSH values, excluding the median of the group with a hypoechogenic thyroid were close to 1.2 mIU/L. The 97.5th percentile in the reference population was 3.35 mIU/L. However, there was no difference compared to the total study population. Conclusion: The upper reference limit for TSH based on a reference population according to NACB criteria came down to 3.35 mIU/L, but not to ~2.5 mIU/L. Interestingly, there is no difference compared to the total study population.

scholarly journals What troponin I level post PCI in SIHD is predictive of higher risk of MACE?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Moosavi ◽  
R Ebrahimi ◽  
Q Yang ◽  
T Harvey ◽  
S.K Das ◽  
...  
Keyword(s):  
Troponin I ◽  
Coronary Intervention ◽  
Cardiac Events ◽  
Reference Limit ◽  
Repeat Revascularization ◽  
Coronary Syndrome ◽  
Clinically Significant ◽  
Universal Definition ◽  
One Year ◽  
Upper Reference Limit

Abstract Background According to the 4th universal definition of myocardial infarction (MI), post percutaneous coronary intervention (PCI) MI is defined as an elevation of cardiac troponin values more than five times above the 99th percentile upper reference limit. The ISCHEMIA Trial in stable ischaemic heart disease (SIHD) patients reported post PCI troponin rise as part of the primary endpoint. What represents a clinically significant troponin rise post PCI has not been clearly established. Purpose The aim of our study was to correlate the level of troponin I rise with adverse events post PCI in SIHD. Methods We performed a retrospective analysis of our PCI registry in patients with SIHD between 2014 and 2018. Patients with acute coronary syndrome were excluded. HS-troponin I was measured one day after the procedure. The primary end point was major adverse cardiac events (MACE) including death, MI, stent thrombosis (ST) and need for repeat revascularization within 12 months from index procedure. Results Between 2014 and 2018, 920 patients (mean age 67.5 years, 78% male) underwent PCI for SIHD. Troponin rise post PCI was a common event and a level more than 100ng/L (reference range &lt;26 ng/L) occurred in 54% of patients. Mean and median troponin I level post PCI was 675 ng/L±2530 and 118 ng/L respectively. In patients with MACE, mean troponin I level was 1361 ng/L compared with 611 ng/L in patients without MACE (P=0.0176). Correlation of troponin I level with one year MACE rates are shown in the Graph. MACE rates were steady at 8.5% with troponin I levels below 2500 ng/L after which there was a significant increase in the MACE rates. At troponin I level above 5000 ng/L MACE was 13.6% and above 10,000 ng/L it was 33.3%. Conclusion Troponin I levels above 2500 ng/L (x100 upper limit normal) correlated with an increase in the risk of MACE in patients undergoing PCI for SIHD. Our results suggest that current definitions of procedural MI overestimate the clinical significance of post PCI troponin rise. Funding Acknowledgement Type of funding source: None

scholarly journals A Methodology for Redesigning Networks by Using Markov Random Fields

Mathematics ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1389
Author(s):  
Julia García Cabello ◽  
Pedro A. Castillo ◽  
Maria-del-Carmen Aguilar-Luzon ◽  
Francisco Chiclana ◽  
Enrique Herrera-Viedma
Keyword(s):  
Decision Making ◽  
Random Fields ◽  
Markov Random Fields ◽  
Application Performance ◽  
Cross Border ◽  
Markov Random ◽  
User Groups ◽  
Universal Definition ◽  
Definition Of ◽  
Decision Making Model

Standard methodologies for redesigning physical networks rely on Geographic Information Systems (GIS), which strongly depend on local demographic specifications. The absence of a universal definition of demography makes its use for cross-border purposes much more difficult. This paper presents a Decision Making Model (DMM) for redesigning networks that works without geographical constraints. There are multiple advantages of this approach: on one hand, it can be used in any country of the world; on the other hand, the absence of geographical constraints widens the application scope of our approach, meaning that it can be successfully implemented either in physical (ATM networks) or non-physical networks such as in group decision making, social networks, e-commerce, e-governance and all fields in which user groups make decisions collectively. Case studies involving both types of situations are conducted in order to illustrate the methodology. The model has been designed under a data reduction strategy in order to improve application performance.

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