Early diagnosis of acute myocardial infarction in patients with pre-existing coronary artery disease using more sensitive cardiac troponin assays

TY - JOUR

T1 - Early diagnosis of acute myocardial infarction in patients with pre-existing coronary artery disease using more sensitive cardiac troponin assays

AU - Reiter, Miriam

AU - Twerenbold, Raphael

AU - Reichlin, Tobias

AU - Benz, Benjamin

AU - Haaf, Philip

AU - Meissner, Julia

AU - Hochholzer, Willibald

AU - Stelzig, Claudia

AU - Freese, Michael

AU - Heinisch, Corinna

AU - Balmelli, Cathrin

AU - Drexler, Beatrice

AU - Freidank, Heike

AU - Winkler, Katrin

AU - Campodarve, Isabel

AU - Gea, Joaquim

AU - Mueller, Christian

N1 - Funding Information: The study was supported by research grants from the Swiss National Science Foundation (PP00B-102853), the Swiss Heart Foundation, Abbott, Roche, Siemens, and the Department of Internal Medicine, University Hospital Basel. Funding Information: Conflict of interest: We disclose that C.M. has received research support from the Swiss National Science Foundation (PP00B-102853), the Swiss Heart Foundation, the Novartis Foundation, the Krokus Foundation, Abbott, Astra Zeneca, Biosite, Brahms, Nanosphere, Roche, Siemens, and the Department of Internal Medicine, University Hospital Basel, as well as speaker honoraria from Abbott, Biosite, Brahms, Roche, and Siemens.

PY - 2012/4

Y1 - 2012/4

N2 - Aims We sought to examine the diagnostic and prognostic utility of sensitive cardiac troponin (cTn) assays in patients with pre-existing coronary artery disease (CAD).Methods and resultsWe conducted a multicentre study to examine the diagnostic accuracy of one high-sensitive and two sensitive cTn assays in 1098 consecutive patients presenting with symptoms suggestive of acute myocardial infarction (AMI), of whom 401 (37) had pre-existing CAD. Measurements of Roche high-sensitive cTnT (hs-cTnT), Siemens cTnI-Ultra, Abbott-Architect cTnI and the standard assay (Roche cTnT) were performed in a blinded fashion. The final diagnosis was adjudicated by two independent cardiologists. Acute myocardial infarction was the final diagnosis in 19 of CAD patients. Among patients with diagnoses other than AMI, baseline cTn levels were elevated above the 99th percentile with Roche hs-cTnT in 40, with Siemens TnI-Ultra in 15, and Abbott-Architect cTnI in 13 of them. In patients with pre-existing CAD, the diagnostic accuracy at presentation, quantified by the area under the receiver operator characteristic curve (AUC), was significantly greater for the sensitive cTn assays compared with the standard assay (AUC for Roche hs-cTnT, 0.92; Siemens cTnI-Ultra, 0.94; and Abbott-Architect cTnI, 0.93 vs. AUC for the standard assay, 0.87; P < 0.01 for all comparisons). Elevated levels of cTn measured with the sensitive assays predicted mortality irrespective of pre-existing CAD, age, sex, and cardiovascular risk factors. Conclusions ensitive cTn assays have high-diagnostic accuracy also in CAD patients. Mild elevations are common in non-AMI patients and test-specific optimal cut-off levels tend to be higher in CAD patients than in patients without history of CAD. Sensitive cTn assays also retain prognostic value. (ClinicalTrials.gov number, NCT00470587).

AB - Aims We sought to examine the diagnostic and prognostic utility of sensitive cardiac troponin (cTn) assays in patients with pre-existing coronary artery disease (CAD).Methods and resultsWe conducted a multicentre study to examine the diagnostic accuracy of one high-sensitive and two sensitive cTn assays in 1098 consecutive patients presenting with symptoms suggestive of acute myocardial infarction (AMI), of whom 401 (37) had pre-existing CAD. Measurements of Roche high-sensitive cTnT (hs-cTnT), Siemens cTnI-Ultra, Abbott-Architect cTnI and the standard assay (Roche cTnT) were performed in a blinded fashion. The final diagnosis was adjudicated by two independent cardiologists. Acute myocardial infarction was the final diagnosis in 19 of CAD patients. Among patients with diagnoses other than AMI, baseline cTn levels were elevated above the 99th percentile with Roche hs-cTnT in 40, with Siemens TnI-Ultra in 15, and Abbott-Architect cTnI in 13 of them. In patients with pre-existing CAD, the diagnostic accuracy at presentation, quantified by the area under the receiver operator characteristic curve (AUC), was significantly greater for the sensitive cTn assays compared with the standard assay (AUC for Roche hs-cTnT, 0.92; Siemens cTnI-Ultra, 0.94; and Abbott-Architect cTnI, 0.93 vs. AUC for the standard assay, 0.87; P < 0.01 for all comparisons). Elevated levels of cTn measured with the sensitive assays predicted mortality irrespective of pre-existing CAD, age, sex, and cardiovascular risk factors. Conclusions ensitive cTn assays have high-diagnostic accuracy also in CAD patients. Mild elevations are common in non-AMI patients and test-specific optimal cut-off levels tend to be higher in CAD patients than in patients without history of CAD. Sensitive cTn assays also retain prognostic value. (ClinicalTrials.gov number, NCT00470587).

KW - Acute myocardial infarction

KW - Coronary artery disease

KW - Diagnosis

KW - Prognosis

KW - Troponin

UR - http://www.scopus.com/inward/record.url?scp=84860132016&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehr376

DO - 10.1093/eurheartj/ehr376

M3 - SCORING: Journal article

C2 - 22044927

AN - SCOPUS:84860132016

VL - 33

SP - 988

EP - 997

JO - EUR HEART J

JF - EUR HEART J

SN - 0195-668X

IS - 8

ER -