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...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2017-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5363912?pdf=render |
| _version_ | 1819020029683826688 |
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| author | Johannes Tobias Neumann Nils Arne Sörensen Francisco Ojeda Thomas Renné Renate B Schnabel Tanja Zeller Mahir Karakas Stefan Blankenberg Dirk Westermann |
| 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 |
| collection | DOAJ |
| 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). |
| first_indexed | 2024-12-21T03:44:43Z |
| format | Article |
| id | doaj.art-ee04d9f5d2b64e5a85952a631c6029b2 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T03:44:43Z |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-ee04d9f5d2b64e5a85952a631c6029b22022-12-21T19:17:08ZengPublic 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 |
| 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 |
| title | 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_short | Early diagnosis of acute myocardial infarction using high-sensitivity troponin I. |
| title_sort | early diagnosis of acute myocardial infarction using high sensitivity troponin i |
| url | http://europepmc.org/articles/PMC5363912?pdf=render |
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