Diagnoses and mortality in a population without acute myocardial infarction, but with elevated highsensitive troponin I – a retrospective register-based single center study

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

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2016.07.678 ◽

2016 ◽

Vol 68 (16) ◽

pp. C179-C180

Author(s):

Si-Tuan Nguyen ◽

Hieu-Hanh Le-Nguyen ◽

Lam Hung Hanh

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Early Diagnosis ◽

Troponin I ◽

High Sensitive Troponin

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Atherosclerotic Renal Artery Stenosis Prevalence and Correlations in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions: Data From Nonrandomized Single‐Center Study (REN‐ACS)—A Single Center, Prospective, Observational Study

Journal of the American Heart Association ◽

10.1161/jaha.115.002379 ◽

2015 ◽

Vol 4 (10) ◽

Cited By ~ 6

Author(s):

Alexandru Burlacu ◽

Dimitrie Siriopol ◽

Luminita Voroneanu ◽

Ionut Nistor ◽

Simona Hogas ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Observational Study ◽

Prospective Observational Study ◽

Percutaneous Coronary Interventions ◽

Single Center ◽

Atherosclerotic Renal Artery Stenosis ◽

Single Center Study ◽

Percutaneous Coronary ◽

Center Study

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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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