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Combining High-Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute Myocardial Infarction

Standard

Combining High-Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute Myocardial Infarction. / van der Linden, Noreen; Wildi, Karin; Twerenbold, Raphael; Pickering, John W; Than, Martin; Cullen, Louise; Greenslade, Jaimi; Parsonage, William; Nestelberger, Thomas; Boeddinghaus, Jasper; Badertscher, Patrick; Rubini Giménez, Maria; Klinkenberg, Lieke J J; Bekers, Otto; Schöni, Aline; Keller, Dagmar I; Sabti, Zaid; Puelacher, Christian; Cupa, Janosch; Schumacher, Lukas; Kozhuharov, Nikola; Grimm, Karin; Shrestha, Samyut; Flores, Dayana; Freese, Michael; Stelzig, Claudia; Strebel, Ivo; Miró, Òscar; Rentsch, Katharina; Morawiec, Beata; Kawecki, Damian; Kloos, Wanda; Lohrmann, Jens; Richards, A Mark; Troughton, Richard; Pemberton, Christopher; Osswald, Stefan; van Dieijen-Visser, Marja P; Mingels, Alma M; Reichlin, Tobias; Meex, Steven J R; Mueller, Christian.

in: CIRCULATION, Jahrgang 138, Nr. 10, 04.09.2018, S. 989-999.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

van der Linden, N, Wildi, K, Twerenbold, R, Pickering, JW, Than, M, Cullen, L, Greenslade, J, Parsonage, W, Nestelberger, T, Boeddinghaus, J, Badertscher, P, Rubini Giménez, M, Klinkenberg, LJJ, Bekers, O, Schöni, A, Keller, DI, Sabti, Z, Puelacher, C, Cupa, J, Schumacher, L, Kozhuharov, N, Grimm, K, Shrestha, S, Flores, D, Freese, M, Stelzig, C, Strebel, I, Miró, Ò, Rentsch, K, Morawiec, B, Kawecki, D, Kloos, W, Lohrmann, J, Richards, AM, Troughton, R, Pemberton, C, Osswald, S, van Dieijen-Visser, MP, Mingels, AM, Reichlin, T, Meex, SJR & Mueller, C 2018, 'Combining High-Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute Myocardial Infarction', CIRCULATION, Jg. 138, Nr. 10, S. 989-999. https://doi.org/10.1161/CIRCULATIONAHA.117.032003

APA

van der Linden, N., Wildi, K., Twerenbold, R., Pickering, J. W., Than, M., Cullen, L., Greenslade, J., Parsonage, W., Nestelberger, T., Boeddinghaus, J., Badertscher, P., Rubini Giménez, M., Klinkenberg, L. J. J., Bekers, O., Schöni, A., Keller, D. I., Sabti, Z., Puelacher, C., Cupa, J., ... Mueller, C. (2018). Combining High-Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute Myocardial Infarction. CIRCULATION, 138(10), 989-999. https://doi.org/10.1161/CIRCULATIONAHA.117.032003

Vancouver

van der Linden N, Wildi K, Twerenbold R, Pickering JW, Than M, Cullen L et al. Combining High-Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute Myocardial Infarction. CIRCULATION. 2018 Sep 4;138(10):989-999. https://doi.org/10.1161/CIRCULATIONAHA.117.032003

Bibtex

@article{f33b86d88baf4237b42ab277905045f6,
title = "Combining High-Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute Myocardial Infarction",
abstract = "BACKGROUND: Combining 2 signals of cardiomyocyte injury, cardiac troponin I (cTnI) and T (cTnT), might overcome some individual pathophysiological and analytical limitations and thereby increase diagnostic accuracy for acute myocardial infarction with a single blood draw. We aimed to evaluate the diagnostic performance of combinations of high-sensitivity (hs) cTnI and hs-cTnT for the early diagnosis of acute myocardial infarction.METHODS: The diagnostic performance of combining hs-cTnI (Architect, Abbott) and hs-cTnT (Elecsys, Roche) concentrations (sum, product, ratio, and a combination algorithm) obtained at the time of presentation was evaluated in a large multicenter diagnostic study of patients with suspected acute myocardial infarction. The optimal rule-out and rule-in thresholds were externally validated in a second large multicenter diagnostic study. The proportion of patients eligible for early rule-out was compared with the European Society of Cardiology 0/1 and 0/3 hour algorithms.RESULTS: Combining hs-cTnI and hs-cTnT concentrations did not consistently increase overall diagnostic accuracy as compared with the individual isoforms. However, the combination improved the proportion of patients meeting criteria for very early rule-out. With the European Society of Cardiology 2015 guideline recommended algorithms and cut-offs, the proportion meeting rule-out criteria after the baseline blood sampling was limited (6% to 24%) and assay dependent. Application of optimized cut-off values using the sum (9 ng/L) and product (18 ng2/L2) of hs-cTnI and hs-cTnT concentrations led to an increase in the proportion ruled-out after a single blood draw to 34% to 41% in the original (sum: negative predictive value [NPV] 100% [95% confidence interval (CI), 99.5% to 100%]; product: NPV 100% [95% CI, 99.5% to 100%]) and in the validation cohort (sum: NPV 99.6% [95% CI, 99.0-99.9%]; product: NPV 99.4% [95% CI, 98.8-99.8%]). The use of a combination algorithm (hs-cTnI <4 ng/L and hs-cTnT <9 ng/L) showed comparable results for rule-out (40% to 43% ruled out; NPV original cohort 99.9% [95% CI, 99.2-100%]; NPV validation cohort 99.5% [95% CI, 98.9-99.8%]) and rule-in (positive predictive value [PPV] original cohort 74.4% [95% Cl, 69.6-78.8%]; PPV validation cohort 84.0% [95% Cl, 79.7-87.6%]).CONCLUSIONS: New strategies combining hs-cTnI and hs-cTnT concentrations may significantly increase the number of patients eligible for very early and safe rule-out, but do not seem helpful for the rule-in of acute myocardial infarction.CLINICAL TRIAL REGISTRATION: URL (APACE): https://www.clinicaltrial.gov . Unique identifier: NCT00470587. URL (ADAPT): www.anzctr.org.au . Unique identifier: ACTRN12611001069943.",
keywords = "Australia, Biomarkers/blood, Early Diagnosis, Europe, Humans, Myocardial Infarction/blood, New Zealand, Predictive Value of Tests, Prospective Studies, Reproducibility of Results, Time Factors, Troponin I/blood, Troponin T/blood, Up-Regulation",
author = "{van der Linden}, Noreen and Karin Wildi and Raphael Twerenbold and Pickering, {John W} and Martin Than and Louise Cullen and Jaimi Greenslade and William Parsonage and Thomas Nestelberger and Jasper Boeddinghaus and Patrick Badertscher and {Rubini Gim{\'e}nez}, Maria and Klinkenberg, {Lieke J J} and Otto Bekers and Aline Sch{\"o}ni and Keller, {Dagmar I} and Zaid Sabti and Christian Puelacher and Janosch Cupa and Lukas Schumacher and Nikola Kozhuharov and Karin Grimm and Samyut Shrestha and Dayana Flores and Michael Freese and Claudia Stelzig and Ivo Strebel and {\`O}scar Mir{\'o} and Katharina Rentsch and Beata Morawiec and Damian Kawecki and Wanda Kloos and Jens Lohrmann and Richards, {A Mark} and Richard Troughton and Christopher Pemberton and Stefan Osswald and {van Dieijen-Visser}, {Marja P} and Mingels, {Alma M} and Tobias Reichlin and Meex, {Steven J R} and Christian Mueller",
year = "2018",
month = sep,
day = "4",
doi = "10.1161/CIRCULATIONAHA.117.032003",
language = "English",
volume = "138",
pages = "989--999",
journal = "CIRCULATION",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

RIS

TY - JOUR

T1 - Combining High-Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute Myocardial Infarction

AU - van der Linden, Noreen

AU - Wildi, Karin

AU - Twerenbold, Raphael

AU - Pickering, John W

AU - Than, Martin

AU - Cullen, Louise

AU - Greenslade, Jaimi

AU - Parsonage, William

AU - Nestelberger, Thomas

AU - Boeddinghaus, Jasper

AU - Badertscher, Patrick

AU - Rubini Giménez, Maria

AU - Klinkenberg, Lieke J J

AU - Bekers, Otto

AU - Schöni, Aline

AU - Keller, Dagmar I

AU - Sabti, Zaid

AU - Puelacher, Christian

AU - Cupa, Janosch

AU - Schumacher, Lukas

AU - Kozhuharov, Nikola

AU - Grimm, Karin

AU - Shrestha, Samyut

AU - Flores, Dayana

AU - Freese, Michael

AU - Stelzig, Claudia

AU - Strebel, Ivo

AU - Miró, Òscar

AU - Rentsch, Katharina

AU - Morawiec, Beata

AU - Kawecki, Damian

AU - Kloos, Wanda

AU - Lohrmann, Jens

AU - Richards, A Mark

AU - Troughton, Richard

AU - Pemberton, Christopher

AU - Osswald, Stefan

AU - van Dieijen-Visser, Marja P

AU - Mingels, Alma M

AU - Reichlin, Tobias

AU - Meex, Steven J R

AU - Mueller, Christian

PY - 2018/9/4

Y1 - 2018/9/4

N2 - BACKGROUND: Combining 2 signals of cardiomyocyte injury, cardiac troponin I (cTnI) and T (cTnT), might overcome some individual pathophysiological and analytical limitations and thereby increase diagnostic accuracy for acute myocardial infarction with a single blood draw. We aimed to evaluate the diagnostic performance of combinations of high-sensitivity (hs) cTnI and hs-cTnT for the early diagnosis of acute myocardial infarction.METHODS: The diagnostic performance of combining hs-cTnI (Architect, Abbott) and hs-cTnT (Elecsys, Roche) concentrations (sum, product, ratio, and a combination algorithm) obtained at the time of presentation was evaluated in a large multicenter diagnostic study of patients with suspected acute myocardial infarction. The optimal rule-out and rule-in thresholds were externally validated in a second large multicenter diagnostic study. The proportion of patients eligible for early rule-out was compared with the European Society of Cardiology 0/1 and 0/3 hour algorithms.RESULTS: Combining hs-cTnI and hs-cTnT concentrations did not consistently increase overall diagnostic accuracy as compared with the individual isoforms. However, the combination improved the proportion of patients meeting criteria for very early rule-out. With the European Society of Cardiology 2015 guideline recommended algorithms and cut-offs, the proportion meeting rule-out criteria after the baseline blood sampling was limited (6% to 24%) and assay dependent. Application of optimized cut-off values using the sum (9 ng/L) and product (18 ng2/L2) of hs-cTnI and hs-cTnT concentrations led to an increase in the proportion ruled-out after a single blood draw to 34% to 41% in the original (sum: negative predictive value [NPV] 100% [95% confidence interval (CI), 99.5% to 100%]; product: NPV 100% [95% CI, 99.5% to 100%]) and in the validation cohort (sum: NPV 99.6% [95% CI, 99.0-99.9%]; product: NPV 99.4% [95% CI, 98.8-99.8%]). The use of a combination algorithm (hs-cTnI <4 ng/L and hs-cTnT <9 ng/L) showed comparable results for rule-out (40% to 43% ruled out; NPV original cohort 99.9% [95% CI, 99.2-100%]; NPV validation cohort 99.5% [95% CI, 98.9-99.8%]) and rule-in (positive predictive value [PPV] original cohort 74.4% [95% Cl, 69.6-78.8%]; PPV validation cohort 84.0% [95% Cl, 79.7-87.6%]).CONCLUSIONS: New strategies combining hs-cTnI and hs-cTnT concentrations may significantly increase the number of patients eligible for very early and safe rule-out, but do not seem helpful for the rule-in of acute myocardial infarction.CLINICAL TRIAL REGISTRATION: URL (APACE): https://www.clinicaltrial.gov . Unique identifier: NCT00470587. URL (ADAPT): www.anzctr.org.au . Unique identifier: ACTRN12611001069943.

AB - BACKGROUND: Combining 2 signals of cardiomyocyte injury, cardiac troponin I (cTnI) and T (cTnT), might overcome some individual pathophysiological and analytical limitations and thereby increase diagnostic accuracy for acute myocardial infarction with a single blood draw. We aimed to evaluate the diagnostic performance of combinations of high-sensitivity (hs) cTnI and hs-cTnT for the early diagnosis of acute myocardial infarction.METHODS: The diagnostic performance of combining hs-cTnI (Architect, Abbott) and hs-cTnT (Elecsys, Roche) concentrations (sum, product, ratio, and a combination algorithm) obtained at the time of presentation was evaluated in a large multicenter diagnostic study of patients with suspected acute myocardial infarction. The optimal rule-out and rule-in thresholds were externally validated in a second large multicenter diagnostic study. The proportion of patients eligible for early rule-out was compared with the European Society of Cardiology 0/1 and 0/3 hour algorithms.RESULTS: Combining hs-cTnI and hs-cTnT concentrations did not consistently increase overall diagnostic accuracy as compared with the individual isoforms. However, the combination improved the proportion of patients meeting criteria for very early rule-out. With the European Society of Cardiology 2015 guideline recommended algorithms and cut-offs, the proportion meeting rule-out criteria after the baseline blood sampling was limited (6% to 24%) and assay dependent. Application of optimized cut-off values using the sum (9 ng/L) and product (18 ng2/L2) of hs-cTnI and hs-cTnT concentrations led to an increase in the proportion ruled-out after a single blood draw to 34% to 41% in the original (sum: negative predictive value [NPV] 100% [95% confidence interval (CI), 99.5% to 100%]; product: NPV 100% [95% CI, 99.5% to 100%]) and in the validation cohort (sum: NPV 99.6% [95% CI, 99.0-99.9%]; product: NPV 99.4% [95% CI, 98.8-99.8%]). The use of a combination algorithm (hs-cTnI <4 ng/L and hs-cTnT <9 ng/L) showed comparable results for rule-out (40% to 43% ruled out; NPV original cohort 99.9% [95% CI, 99.2-100%]; NPV validation cohort 99.5% [95% CI, 98.9-99.8%]) and rule-in (positive predictive value [PPV] original cohort 74.4% [95% Cl, 69.6-78.8%]; PPV validation cohort 84.0% [95% Cl, 79.7-87.6%]).CONCLUSIONS: New strategies combining hs-cTnI and hs-cTnT concentrations may significantly increase the number of patients eligible for very early and safe rule-out, but do not seem helpful for the rule-in of acute myocardial infarction.CLINICAL TRIAL REGISTRATION: URL (APACE): https://www.clinicaltrial.gov . Unique identifier: NCT00470587. URL (ADAPT): www.anzctr.org.au . Unique identifier: ACTRN12611001069943.

KW - Australia

KW - Biomarkers/blood

KW - Early Diagnosis

KW - Europe

KW - Humans

KW - Myocardial Infarction/blood

KW - New Zealand

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Reproducibility of Results

KW - Time Factors

KW - Troponin I/blood

KW - Troponin T/blood

KW - Up-Regulation

U2 - 10.1161/CIRCULATIONAHA.117.032003

DO - 10.1161/CIRCULATIONAHA.117.032003

M3 - SCORING: Journal article

C2 - 29691270

VL - 138

SP - 989

EP - 999

JO - CIRCULATION

JF - CIRCULATION

SN - 0009-7322

IS - 10

ER -