Early diagnosis of acute myocardial infarction using high-sensitivity troponin I.
OBJECTIVE:There is a clinical need for early and accurate diagnosis of acute myocardial infarction (AMI). Current European Society of Cardiology (ESC) guidelines recommend diagnosis of non-ST-elevation AMI based on serial troponin measurements. We aimed to challenge the ESC guidelines using 1) a hig...
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doaj-ee04d9f5d2b64e5a85952a631c6029b22020-11-25T01:35:15ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01123e017428810.1371/journal.pone.0174288Early diagnosis of acute myocardial infarction using high-sensitivity troponin I.Johannes Tobias NeumannNils Arne SörensenFrancisco OjedaThomas RennéRenate B SchnabelTanja ZellerMahir KarakasStefan BlankenbergDirk WestermannOBJECTIVE:There is a clinical need for early and accurate diagnosis of acute myocardial infarction (AMI). Current European Society of Cardiology (ESC) guidelines recommend diagnosis of non-ST-elevation AMI based on serial troponin measurements. We aimed to challenge the ESC guidelines using 1) a high-sensitivity troponin I (hs-TnI) baseline cutoff, 2) an absolute hs-TnI change after 1 hour and 3) additional application of an ischemic ECG. METHODS:1,516 patients with suspected AMI presenting to the emergency department were included. Hs-TnI was measured directly at admission, after 1 and 3 hours. We investigated baseline concentrations, absolute changes of hs-TnI and additional application of an ischemic ECG to diagnose AMI. A positive predictive value (PPV) of more than 85% was targeted. RESULTS:The median age of the study population was 65 years; 291 patients were diagnosed with AMI. The PPV of the 3-hours ESC algorithm was 85.5% (CI 79.7, 90.1) and 65.8% (CI 60.5,70.8) for the 1-hour algorithm. Using a high baseline hs-TnI concentration of 150 ng/L resulted in a PPV of 87.8% (CI 80.9,92.9). Alternatively, a hs-TnI change of 20 ng/L after 1 hour, resulted in a PPV of 86.5% (80.9,91.0), respectively for the diagnosis of AMI. Additional use of an ischemic ECG increased the PPV to 90.5% (CI 83.2,95.3), while reducing the efficacy. CONCLUSION:The diagnosis of AMI based on hs-TnI is challenging. The application of absolute hs-TnI changes after 1 hour may facilitate rapid rule-in of patients. TRIAL REGISTRATION:www.clinicaltrials.gov (NCT02355457).http://europepmc.org/articles/PMC5363912?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Johannes Tobias Neumann Nils Arne Sörensen Francisco Ojeda Thomas Renné Renate B Schnabel Tanja Zeller Mahir Karakas Stefan Blankenberg Dirk Westermann |
spellingShingle |
Johannes Tobias Neumann Nils Arne Sörensen Francisco Ojeda Thomas Renné Renate B Schnabel Tanja Zeller Mahir Karakas Stefan Blankenberg Dirk Westermann Early diagnosis of acute myocardial infarction using high-sensitivity troponin I. PLoS ONE |
author_facet |
Johannes Tobias Neumann Nils Arne Sörensen Francisco Ojeda Thomas Renné Renate B Schnabel Tanja Zeller Mahir Karakas Stefan Blankenberg Dirk Westermann |
author_sort |
Johannes Tobias Neumann |
title |
Early diagnosis of acute myocardial infarction using high-sensitivity troponin I. |
title_short |
Early diagnosis of acute myocardial infarction using high-sensitivity troponin I. |
title_full |
Early diagnosis of acute myocardial infarction using high-sensitivity troponin I. |
title_fullStr |
Early diagnosis of acute myocardial infarction using high-sensitivity troponin I. |
title_full_unstemmed |
Early diagnosis of acute myocardial infarction using high-sensitivity troponin I. |
title_sort |
early diagnosis of acute myocardial infarction using high-sensitivity troponin i. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2017-01-01 |
description |
OBJECTIVE:There is a clinical need for early and accurate diagnosis of acute myocardial infarction (AMI). Current European Society of Cardiology (ESC) guidelines recommend diagnosis of non-ST-elevation AMI based on serial troponin measurements. We aimed to challenge the ESC guidelines using 1) a high-sensitivity troponin I (hs-TnI) baseline cutoff, 2) an absolute hs-TnI change after 1 hour and 3) additional application of an ischemic ECG. METHODS:1,516 patients with suspected AMI presenting to the emergency department were included. Hs-TnI was measured directly at admission, after 1 and 3 hours. We investigated baseline concentrations, absolute changes of hs-TnI and additional application of an ischemic ECG to diagnose AMI. A positive predictive value (PPV) of more than 85% was targeted. RESULTS:The median age of the study population was 65 years; 291 patients were diagnosed with AMI. The PPV of the 3-hours ESC algorithm was 85.5% (CI 79.7, 90.1) and 65.8% (CI 60.5,70.8) for the 1-hour algorithm. Using a high baseline hs-TnI concentration of 150 ng/L resulted in a PPV of 87.8% (CI 80.9,92.9). Alternatively, a hs-TnI change of 20 ng/L after 1 hour, resulted in a PPV of 86.5% (80.9,91.0), respectively for the diagnosis of AMI. Additional use of an ischemic ECG increased the PPV to 90.5% (CI 83.2,95.3), while reducing the efficacy. CONCLUSION:The diagnosis of AMI based on hs-TnI is challenging. The application of absolute hs-TnI changes after 1 hour may facilitate rapid rule-in of patients. TRIAL REGISTRATION:www.clinicaltrials.gov (NCT02355457). |
url |
http://europepmc.org/articles/PMC5363912?pdf=render |
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