Early diagnosis of acute myocardial infarction in patients with mild elevations of cardiac troponin
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Early diagnosis of acute myocardial infarction in patients with mild elevations of cardiac troponin. / Boeddinghaus, Jasper; Reichlin, Tobias; Nestelberger, Thomas; Twerenbold, Raphael; Meili, Yvette; Wildi, Karin; Hillinger, Petra; Giménez, Maria Rubini; Cupa, Janosch; Schumacher, Lukas; Schubera, Marie; Badertscher, Patrick; Corbière, Sydney; Grimm, Karin; Puelacher, Christian; Sabti, Zaid; Widmer, Dayana Flores; Schaerli, Nicolas; Kozhuharov, Nikola; Shrestha, Samyut; Bürge, Tobias; Mächler, Patrick; Büchi, Michael; Rentsch, Katharina; Miró, Òscar; López, Beatriz; Martin-Sanchez, F. Javier; Rodriguez-Adrada, Esther; Morawiec, Beata; Kawecki, Damian; Ganovská, Eva; Parenica, Jiri; Lohrmann, Jens; Buser, Andreas; Keller, Dagmar I.; Osswald, Stefan; Mueller, Christian.
in: CLIN RES CARDIOL, Jahrgang 106, Nr. 6, 01.06.2017, S. 457-467.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Early diagnosis of acute myocardial infarction in patients with mild elevations of cardiac troponin
AU - Boeddinghaus, Jasper
AU - Reichlin, Tobias
AU - Nestelberger, Thomas
AU - Twerenbold, Raphael
AU - Meili, Yvette
AU - Wildi, Karin
AU - Hillinger, Petra
AU - Giménez, Maria Rubini
AU - Cupa, Janosch
AU - Schumacher, Lukas
AU - Schubera, Marie
AU - Badertscher, Patrick
AU - Corbière, Sydney
AU - Grimm, Karin
AU - Puelacher, Christian
AU - Sabti, Zaid
AU - Widmer, Dayana Flores
AU - Schaerli, Nicolas
AU - Kozhuharov, Nikola
AU - Shrestha, Samyut
AU - Bürge, Tobias
AU - Mächler, Patrick
AU - Büchi, Michael
AU - Rentsch, Katharina
AU - Miró, Òscar
AU - López, Beatriz
AU - Martin-Sanchez, F. Javier
AU - Rodriguez-Adrada, Esther
AU - Morawiec, Beata
AU - Kawecki, Damian
AU - Ganovská, Eva
AU - Parenica, Jiri
AU - Lohrmann, Jens
AU - Buser, Andreas
AU - Keller, Dagmar I.
AU - Osswald, Stefan
AU - Mueller, Christian
N1 - Publisher Copyright: © 2017, Springer-Verlag Berlin Heidelberg.
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Background: The early diagnosis of acute myocardial infarction (AMI) in patients with mild elevations of high-sensitivity cardiac troponin (hs-cTn) is a challenge. It is unclear whether copeptin, a marker of endogenous stress, or 1h-hs-cTn changes are better suited to address this important unmet clinical need. Methods: We prospectively enrolled patients presenting with symptoms suggestive of AMI to the emergency department (ED). Two independent cardiologists adjudicated the final diagnosis. Mild hs-cTn elevations were defined as 26.2 ng/L (99th percentile) to 75 ng/L for hs-cTnI, and 14 ng/L (99th percentile) to 50 ng/L (biological-equivalent to 75 ng/L for hs-cTnI) for hs-cTnT. Results: Among 1356 patients, 80 (6%) had mild hs-cTnI elevations at presentation. Within this group, AMI was the final diagnosis in 39 patients (49%). The diagnostic accuracy for the diagnosis of AMI as quantified by the area under the receiver operating characteristic curve (AUC) was 0.51 (95% CI 0.39–0.64) for hs-cTnI at presentation, 0.58 (95% CI 0.45–0.71) for copeptin at presentation, and 0.78 (95% CI 0.68–0.88) for 1h-hs-cTnI changes, which was significantly higher as compared to copeptin (p = 0.02) or hs-cTnI alone (p < 0.001). The additional use of 1h-hs-cTnI changes, but not of copeptin, improved diagnostic accuracy of hs-cTnI at presentation (AUC 0.80, 95% CI 0.70–0.90; p = 0.002 for comparison). Similar findings regarding copeptin and 1h-hs-cTnT/I changes were obtained for mild hs-cTnT elevations. Conclusions: About 6–22% of patients presenting with suggestive AMI to the ED have mild hs-cTnT/I elevations at presentation. In contrast to copeptin, the addition of 1h-hs-cTn changes substantially improves the early diagnosis of AMI.
AB - Background: The early diagnosis of acute myocardial infarction (AMI) in patients with mild elevations of high-sensitivity cardiac troponin (hs-cTn) is a challenge. It is unclear whether copeptin, a marker of endogenous stress, or 1h-hs-cTn changes are better suited to address this important unmet clinical need. Methods: We prospectively enrolled patients presenting with symptoms suggestive of AMI to the emergency department (ED). Two independent cardiologists adjudicated the final diagnosis. Mild hs-cTn elevations were defined as 26.2 ng/L (99th percentile) to 75 ng/L for hs-cTnI, and 14 ng/L (99th percentile) to 50 ng/L (biological-equivalent to 75 ng/L for hs-cTnI) for hs-cTnT. Results: Among 1356 patients, 80 (6%) had mild hs-cTnI elevations at presentation. Within this group, AMI was the final diagnosis in 39 patients (49%). The diagnostic accuracy for the diagnosis of AMI as quantified by the area under the receiver operating characteristic curve (AUC) was 0.51 (95% CI 0.39–0.64) for hs-cTnI at presentation, 0.58 (95% CI 0.45–0.71) for copeptin at presentation, and 0.78 (95% CI 0.68–0.88) for 1h-hs-cTnI changes, which was significantly higher as compared to copeptin (p = 0.02) or hs-cTnI alone (p < 0.001). The additional use of 1h-hs-cTnI changes, but not of copeptin, improved diagnostic accuracy of hs-cTnI at presentation (AUC 0.80, 95% CI 0.70–0.90; p = 0.002 for comparison). Similar findings regarding copeptin and 1h-hs-cTnT/I changes were obtained for mild hs-cTnT elevations. Conclusions: About 6–22% of patients presenting with suggestive AMI to the ED have mild hs-cTnT/I elevations at presentation. In contrast to copeptin, the addition of 1h-hs-cTn changes substantially improves the early diagnosis of AMI.
KW - Acute myocardial infarction
KW - Copeptin
KW - Diagnosis of AMI
UR - http://www.scopus.com/inward/record.url?scp=85011298970&partnerID=8YFLogxK
U2 - 10.1007/s00392-016-1075-9
DO - 10.1007/s00392-016-1075-9
M3 - SCORING: Journal article
C2 - 28150185
AN - SCOPUS:85011298970
VL - 106
SP - 457
EP - 467
JO - CLIN RES CARDIOL
JF - CLIN RES CARDIOL
SN - 1861-0684
IS - 6
ER -
