Niklas Schofer1, Fabian J Brunner1, Michael Schlüter1, Francisco Ojeda1, Tanja Zeller1, Stephan Baldus2, Christoph Bickel3, Karl J Lackner4, Thomas Münzel5, Stergios Tzikas5,6, Sabine Genth-Zotz7, Ascan Warnholtz8, Felix Post5,7, Till Keller9, Britta U Goldmann1,10, Stefan Blankenberg1. 1. 1 Department of General and Interventional Cardiology, University Heart Center, Germany. 2. 2 Herzzentrum der Universität zu Köln, Germany. 3. 3 Department of Internal Medicine, Federal Armed Forces Hospital Koblenz, Germany. 4. 4 Department of Laboratory Medicine, Johannes Gutenberg University, Germany. 5. 5 Department of Medicine II University Medical Center, Johannes Gutenberg University, Germany. 6. 6 3rd Department of Cardiology, Aristotle University of Thessaloniki, Greece. 7. 7 Department of Internal Medicine I, Katholisches Klinikum Mainz, Germany. 8. 8 Cardiology Practice Griesheim, Germany. 9. 9 Department of Cardiology, Johann Wolfgang Goethe University Hospital, Germany. 10. 10 Department of Cardiology, Asklepios Klinik Harburg, Germany.
Abstract
BACKGROUND: The determination of cardiac troponin is essential for diagnosing myocardial infarction. A troponin I assay has recently been developed that provides the highest analytical sensitivity to date. METHODS: The analysis included 1560 patients with chest pain, of whom 1098 were diagnosed with non-coronary chest pain, 189 with unstable angina pectoris and 273 with non-ST-segment elevation myocardial infarction. The troponin I concentration was determined on admission (0 hours) and 3 hours later. The diagnostic algorithm incorporated troponin I elevation above the gender-specific 99th percentile as well as predefined relative or absolute 3-hour changes in the troponin I concentration (delta). RESULTS: The diagnostic criterion of troponin I above the 99th percentile resulted in a negative predictive value of 98.0% and 98.2% in men and women, respectively. For rule-in of non-ST-segment elevation myocardial infarction, the use of absolute deltas yielded higher positive predictive values and sensitivities compared to relative deltas. With detection rates of about 85% and 82% in men and women, respectively, non-ST-segment elevation myocardial infarction was diagnosed with a positive predictive value close to 84% in men and 80% in women. CONCLUSIONS: The investigational troponin I assay provides an excellent non-ST-segment elevation myocardial infarction rule out. With gender-specific differences, the application of absolute changes in troponin concentration was superior to relative changes to rule in patients with non-ST-segment elevation myocardial infarction.
BACKGROUND: The determination of cardiac troponin is essential for diagnosing myocardial infarction. A troponin I assay has recently been developed that provides the highest analytical sensitivity to date. METHODS: The analysis included 1560 patients with chest pain, of whom 1098 were diagnosed with non-coronary chest pain, 189 with unstable angina pectoris and 273 with non-ST-segment elevation myocardial infarction. The troponin I concentration was determined on admission (0 hours) and 3 hours later. The diagnostic algorithm incorporated troponin I elevation above the gender-specific 99th percentile as well as predefined relative or absolute 3-hour changes in the troponin I concentration (delta). RESULTS: The diagnostic criterion of troponin I above the 99th percentile resulted in a negative predictive value of 98.0% and 98.2% in men and women, respectively. For rule-in of non-ST-segment elevation myocardial infarction, the use of absolute deltas yielded higher positive predictive values and sensitivities compared to relative deltas. With detection rates of about 85% and 82% in men and women, respectively, non-ST-segment elevation myocardial infarction was diagnosed with a positive predictive value close to 84% in men and 80% in women. CONCLUSIONS: The investigational troponin I assay provides an excellent non-ST-segment elevation myocardial infarction rule out. With gender-specific differences, the application of absolute changes in troponin concentration was superior to relative changes to rule in patients with non-ST-segment elevation myocardial infarction.
Authors: Jes-Niels Boeckel; Lars Palapies; Jens Klotsche; Tanja Zeller; Beatrice von Jeinsen; Maya F Perret; Soeren L Kleinhaus; Lars Pieper; Stergios Tzikas; David Leistner; Christoph Bickel; Günter K Stalla; Hendrik Lehnert; Bertil Lindahl; Hans-Ulrich Wittchen; Sigmund Silber; Stephan Baldus; Winfried Maerz; Stefanie Dimmeler; Stefan Blankenberg; Thomas Münzel; Andreas M Zeiher; Till Keller Journal: Sci Rep Date: 2018-05-24 Impact factor: 4.379