GW27-e0562 The value of high sensitive troponin-i in early diagnosis Of acute myocardial infarction

Aim: To explore, which differential diagnoses to consider in individuals with elevated troponins without acute myocardial infarction (AMI), and the mortality for those individuals. Methods: Retrospective, register-based study on a representative sample of the Danish population with the following inclusion criteria: High-sensitive troponin I (hs-TnI) ≥25 ng/L, age ≥18 years, and exclusion of AMI. Results: 3067 individuals without AMI but increased hs-TnI were included. Most frequent discharge diagnoses: Pneumonia (12.8%), Aortic valve disorder (11.3%), Medical observation (10.9%) and Heart failure (8.9%). The 30-days and one-year mortality was 15.8% and 32.0%, respectively. Conclusions: A selected number of alternative diagnoses must be considered in individuals with increased hs-TnI. Due to high mortality it is crucial to carefully evaluate these individuals despite the absence of AMI.

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P2673Challenging time limits: Using a single high-sensitive troponin I to rule-out acute myocardial infarction in early presenters

European Heart Journal ◽

10.1093/eurheartj/ehz748.0991 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Hansen ◽

C Bang ◽

K G Lauridsen ◽

C A Frederiksen ◽

M Schmidt ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Chest Pain ◽

Troponin I ◽

Regional Hospital ◽

Late Presenters ◽

Siemens Healthcare ◽

High Sensitive Troponin ◽

Rule Out

Abstract Introduction According to ESC guidelines, an acute myocardial infarction (MI) can be excluded without serial troponin measurements in patients presenting with a single high-sensitive troponin below the 99th percentile and chest pain starting >6 hours prior to admission. However, it is unclear if single-testing of high-sensitive troponin can rule-out MI in early presenters. Purpose To investigate the diagnostic performance of a single value of high-sensitive cardiac troponin I (hs-cTnI) at presentation for ruling-out MI in patients presenting with chest pain to the Emergency Department irrespective of chest pain onset. Methods We conducted a substudy of preliminary data from the RACING-MI trial. We included patients presenting with chest pain suggestive of MI to the Emergency Department of a Regional Hospital. We used the Siemens hs-cTnI (Siemens Healthcare, TNIH, Limit of detection: 2.21 ng/L) and a diagnostic cut-off value <3 ng/L to rule-out MI at presentation. Two physicians independently adjudicated the final diagnosis based on all clinical information. Patients were stratified based on time from chest pain onset to hospital admission as very early (0–3 hours), early (3–6 hours) and late presenters (>6 hours). Results We included 989 patients with available hs-cTnI results at admission. MI was confirmed in 82 (8.3%) patients. Using hs-cTnI <3 ng/L as diagnostic cut-off value at presentation, 302 (30.5%) patients without MI were classified as rule-out. Overall, the negative predictive value (NPV) for MI was 100% (95% CI 98.7–100). Based on chest pain onset, 33.8% of patients were classified as very early, 12.8% as early, and 42.7% as late presenters, with 10.7% patients with unreported/unknown onset. NPV was 100% (95% CI 96.5–100) for very early, 100% (95% CI 88.3–100) for early and 100% (95% CI 97.3–100) for late presenters. Conclusions Using a single hs-cTnI value <3ng/L as diagnostic cut-off to rule-out MI seems to be safe and to allow rapid rule-out of MI in patients presenting with chest pain to the emergency department, even in very early presenters. ClinicalTrials.gov Identifier: NCT03634384. Acknowledgement/Funding Randers Regional Hospital, A.P Møller Foundation, Boserup Foundation, Korning Foundation, Højmosegård Grant, Siemens Healthcare (TNIH assays), etc.

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Optimal cutoff-value of a high-sensitive cardiac troponin I assay in patients with kidney disease for the early diagnosis of acute myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/eht310.4413 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. 4413-4413

Author(s):

R. Twerenbold ◽

T. Reichlin ◽

P. H. Haaf ◽

S. Sou ◽

T. Hochgruber ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Kidney Disease ◽

Early Diagnosis ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Optimal Cutoff ◽

Cutoff Value

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The value of highly sensitive troponin in the early diagnosis of acute myocardial infarction.

Clinical Medicine (Russian Journal) ◽

10.18821/0023-2149-2018-96-1-25-29 ◽

2018 ◽

Vol 96 (1) ◽

pp. 25-29

Author(s):

N. N. Borovkov ◽

Natalya A. Golitsyna

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Early Diagnosis ◽

Diagnostic Accuracy ◽

Clinical Significance ◽

Cardiac Troponin ◽

Troponin I ◽

Highly Sensitive ◽

Highly Sensitive Troponin ◽

Sensitivity Specificity

Aim. Study the immediate clinical significance of determination of highly sensitive troponin (high sensitive cardiac troponin - hscTn) in the early diagnosis of acute myocardial infarction (AMI). Material and methods. The analysis of nosological diagnosis in 92 patients with acute coronary syndrome (ACS), urgently hospitalized in the coronary care unit of the Nizhny Novgorod regional hospital. N.A. Semashko. The time from the moment of development of pain syndrome, hospitalization in a hospital ranged from 40 minutes to 4 hours, averaging 2.5 ± 0.32 hours. During hospitalization of patients in the complex diagnosis of AMI in addition to General clinical examination, ECG was determined by the content hscTn and troponin I. All patients in the hospital was performed selective coronary angiography (SCG). Evaluated the sensitivity, specificity and diagnostic accuracy hscTn in comparison with troponin I. Analysis results were represented as a percentage and using a software package "STATISTICA 10.0" (StatSoft, Inc., USA). Results. AMI is diagnosed in 74% of cases (n=68), and the rest 26% (n=24) unstable (progressive) angina (NS). Transmural myocardial infarction or Q-wave myocardial infarction detected in 54% (n=37) of patients. Intramural myocardial infarction or non Q-wave myocardial infarction - in 46% (n=31). AMI re-seen in 27% (n=18). Importance of the study of both cardiac troponin in the early diagnosis of AMI showed the following. Sensitivity hscTn reached 98%, while troponin I - 88%. Specificity hscTn was 79%, and troponin I, only 66%. Overall diagnostic accuracy hscTn was 92%, troponin I less - 83%). Conclusion. The results of the study indicate a predominant clinical significance hscTn in comparison with troponin I in early diagnosis of AMI in the parameters of sensitivity, specificity and diagnostic accuracy.

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Interpretation of high sensitive troponin assays: acute or chronic myocardial damage?

Orvosi Hetilap ◽

10.1556/oh.2011.29202 ◽

2011 ◽

Vol 152 (38) ◽

pp. 1528-1534 ◽

Cited By ~ 1

Author(s):

Eszter Szánthó ◽

Zoltán Szabó ◽

József Varga ◽

György Paragh ◽

Anna V. Oláh

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Creatine Kinase ◽

Troponin I ◽

Troponin T ◽

Troponin Level ◽

Cardiac Damage ◽

Creatine Kinase Mb ◽

Two Samples ◽

High Sensitive Troponin

Troponin is the first choice in the diagnosis of acute myocardial infarction. Correct interpretation is challenging, because high sensitive troponin tests used today detect even the smallest cardiac damage. Methods: High sensitive troponin T (Roche) and troponin I (Mitsubishi Pathfast) and creatine-kinase activity were measured in 20 patients, each having two samples with the time lapse 3–9 hours. Results: In the group without acute myocardial infarction (n = 10) no significant increase in creatine-kinase and creatine-kinase-MB levels were seen, and the mild raise of troponins was due to other cardiovascular problems (atrial fibrillation, paroxysmal supraventricular tachycardia). With acute myocardial infarction (n = 10) a dramatic increase of troponin levels was found in the second samples, and also an increase of creatine-kinase and creatine-kinase-MB activity. According to Fischer-probe a twofold or higher increase of troponin implies 19-times higher risk of acute myocardial infarction in the case of troponin T and 8-times odds ratio at troponin I. Conclusions: The patient’s accompanying diseases should always be considered. If the troponin level is elevated, the measurement should be repeated within 3–6 hours. When troponin shows at least a twofold increase and the patient has chest pain or positive ECG, AMI is likely, and the patient needs special medical care. Although the first troponin level might be elevated if accompanying diseases cause chronic cardiac damage, it can be differentiated by a second troponin measurement. Orv. Hetil., 2011, 152, 1528–1534.

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