Thomas Nestelberger1,2,3, Jasper Boeddinghaus1,2, Maria Rubini Giménez1,2,4, Pedro Lopez-Ayala1,2, Paul David Ratmann1,2, Patrick Badertscher1,2,5, Karin Wildi1,2,6, Desiree Wussler1,2, Luca Koechlin1,2,7, Ketina Arslani1,2, Tobias Zimmermann1,2, Michael Freese1,2, Therese Rinderknecht1,2, Òscar Miró2,8, F Javier Martin-Sanchez2,9, Damian Kawecki2,10, Nicolas Geigy11, Dagmar Keller12, Raphael Twerenbold1,2, Christian Müller1,2. 1. Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland. 2. GREAT Network, Via Antonio Serra 54, 00191 Rome, Italy. 3. Division of Cardiology, Vancouver General Hospital, University of British Columbia, 899 12th Avenue West, V5Z 1M9 Vancouver BC, Canada. 4. Department of Internal Medicine and Cardiology, Heart Center Leipzig-University Hospital, Strümpellstrasse 39, 04289 Leipzig, Germany. 5. Department of Cardiology, Medical University of South Carolina, 179 Ashley Avenue, Charleston, SC, USA. 6. Critical Care Research Institute, The Prince Charles Hospital, Brisbane and University of Queensland, 627 Rode Road, Chemside Queensland 4032, Brisbane, Australia. 7. Department of Cardiac Surgery, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. 8. Emergency Department, Hospital Clinic, Barcelona, Villarroel 170, 08036 Barcelona, Spain. 9. Servicio de Urgencias, Hospital Clínico San Carlos, Profesor Martin Lagos, 28040, Madrid, Spain. 10. 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Poniatowskiego 15, 40-055 Katowice, Poland. 11. Emergency Department, Kantonsspital Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland. 12. Emergency Department, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
Abstract
AIMS: To directly compare the diagnostic accuracy of high-sensitivity cardiac troponin (hs-cTn) T vs. hs-cTnI in the early non-invasive differentiation of Type 1 myocardial infarction (T1MI) due to plaque rupture and atherothrombosis from Type 2 myocardial infarction (T2MI) due to supply-demand mismatch. METHODS AND RESULTS: In a prospective multicentre diagnostic study, two independent cardiologists centrally adjudicated the final diagnosis of T1MI vs. T2MI according to the fourth universal definition of myocardial infarction (MI), using all available clinical information including cardiac imaging in patients presenting with acute chest pain. Diagnostic accuracy was quantified by the area under the receiver operating characteristics curve (AUC). The most extensively validated hs-cTnT-Elecsys and hs-cTnI-Architect assays were measured at presentation, 1 h, and 2 h. Among 5887 patients, 1106 (19%) had a final diagnosis of MI, including 860 (78%) T1MI and 246 (22%) T2MI. The AUC of hs-cTnT-Elecsys to differentiate T1MI from T2MI was moderate and comparable to that provided by hs-cTnI-Architect: hs-cTnT-Elecsys AUC-presentation 0.67 [95% confidence interval (CI) 0.64-0.71], AUC-1 h 0.70 (95% CI 0.66-0.74), and AUC-2 h 0.71 (95% CI 0.66-0.75) vs. hs-cTnI-Architect AUC-presentation 0.71 (95% CI 0.67-0.74), AUC-1 h 0.72 (95% CI 0.68-0.76), and AUC-2 h 0.74 (95% CI 0.69-0.78), all P = not significant (NS). Similarly, the AUC of absolute changes was moderate and comparable for hs-cTnT-Elecsys and hs-cTnI-Architect (all P = NS). Cut-off concentrations achieving at least 90% specificity for the differentiation of T1MI vs. T2MI were >114 ng/L for hs-cTnT-Elecsys [odds ratio (OR) 4.2, 95% CI 2.7-6.6] and >371 ng/L for hs-cTnI-Architect (OR 4.0, 95% CI 2.6-6.2). CONCLUSION: hs-cTnT-Elecsys and hs-cTnI-Architect provided comparable, albeit only moderate, diagnostic accuracy for the early differentiation of T1MI vs. T2MI. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number, NCT00470587, https://clinicaltrials.gov/ct2/show/NCT00470587. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To directly compare the diagnostic accuracy of high-sensitivity cardiac troponin (hs-cTn) T vs. hs-cTnI in the early non-invasive differentiation of Type 1 myocardial infarction (T1MI) due to plaque rupture and atherothrombosis from Type 2 myocardial infarction (T2MI) due to supply-demand mismatch. METHODS AND RESULTS: In a prospective multicentre diagnostic study, two independent cardiologists centrally adjudicated the final diagnosis of T1MI vs. T2MI according to the fourth universal definition of myocardial infarction (MI), using all available clinical information including cardiac imaging in patients presenting with acute chest pain. Diagnostic accuracy was quantified by the area under the receiver operating characteristics curve (AUC). The most extensively validated hs-cTnT-Elecsys and hs-cTnI-Architect assays were measured at presentation, 1 h, and 2 h. Among 5887 patients, 1106 (19%) had a final diagnosis of MI, including 860 (78%) T1MI and 246 (22%) T2MI. The AUC of hs-cTnT-Elecsys to differentiate T1MI from T2MI was moderate and comparable to that provided by hs-cTnI-Architect: hs-cTnT-Elecsys AUC-presentation 0.67 [95% confidence interval (CI) 0.64-0.71], AUC-1 h 0.70 (95% CI 0.66-0.74), and AUC-2 h 0.71 (95% CI 0.66-0.75) vs. hs-cTnI-Architect AUC-presentation 0.71 (95% CI 0.67-0.74), AUC-1 h 0.72 (95% CI 0.68-0.76), and AUC-2 h 0.74 (95% CI 0.69-0.78), all P = not significant (NS). Similarly, the AUC of absolute changes was moderate and comparable for hs-cTnT-Elecsys and hs-cTnI-Architect (all P = NS). Cut-off concentrations achieving at least 90% specificity for the differentiation of T1MI vs. T2MI were >114 ng/L for hs-cTnT-Elecsys [odds ratio (OR) 4.2, 95% CI 2.7-6.6] and >371 ng/L for hs-cTnI-Architect (OR 4.0, 95% CI 2.6-6.2). CONCLUSION: hs-cTnT-Elecsys and hs-cTnI-Architect provided comparable, albeit only moderate, diagnostic accuracy for the early differentiation of T1MI vs. T2MI. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number, NCT00470587, https://clinicaltrials.gov/ct2/show/NCT00470587. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Christian Schulte; Bhawana Singh; Konstantinos Theofilatos; Nils A Sörensen; Jonas Lehmacher; Tau Hartikainen; Paul M Haller; Dirk Westermann; Tanja Zeller; Stefan Blankenberg; Johannes T Neumann; Manuel Mayr Journal: J Mol Cell Cardiol Plus Date: 2022-09