Early diagnosis of acute myocardial infarction in the elderly using more sensitive cardiac troponin assays
Standard
Early diagnosis of acute myocardial infarction in the elderly using more sensitive cardiac troponin assays. / Reiter, Miriam; Twerenbold, Raphael; Reichlin, Tobias; Haaf, Philip; Peter, Frederico; Meissner, Julia; Hochholzer, Willibald; Stelzig, Claudia; Freese, Michael; Heinisch, Corinna; Breidthardt, Tobias; Freidank, Heike; Winkler, Katrin; Campodarve, Isabel; Gea, Joaquim; Mueller, Christian.
in: EUR HEART J, Jahrgang 32, Nr. 11, 06.2011, S. 1379-89.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Early diagnosis of acute myocardial infarction in the elderly using more sensitive cardiac troponin assays
AU - Reiter, Miriam
AU - Twerenbold, Raphael
AU - Reichlin, Tobias
AU - Haaf, Philip
AU - Peter, Frederico
AU - Meissner, Julia
AU - Hochholzer, Willibald
AU - Stelzig, Claudia
AU - Freese, Michael
AU - Heinisch, Corinna
AU - Breidthardt, Tobias
AU - Freidank, Heike
AU - Winkler, Katrin
AU - Campodarve, Isabel
AU - Gea, Joaquim
AU - Mueller, Christian
PY - 2011/6
Y1 - 2011/6
N2 - AIMS: To examine the diagnostic accuracy of sensitive cardiac troponin (cTn) assays in elderly patients, since elevated levels with sensitive cTn assays were reported in 20% of elderly patients without acute myocardial infarction (AMI).METHODS AND RESULTS: In this multi-centre study, we included 1098 consecutive patients presenting with symptoms suggestive of AMI, 406 (37%) were >70 years old. Measurement of three investigational sensitive cTn assays [Roche high-sensitive cTnT (hs-cTnT), Siemens cTnI-Ultra, and Abbott-Architect cTnI) and the standard assay (Roche cTnT) was performed in a blinded fashion. The final diagnosis was adjudicated by two independent cardiologists. Acute myocardial infarction was the adjudicated final diagnosis in 24% of elderly patients. Among elderly patients without AMI, baseline cTn levels were elevated above the 99th percentile in 51% with Roche hs-cTnT, in 17% with Siemens TnI-Ultra, and 13% with Abbott-Architect cTnI. The diagnostic accuracy as quantified by the area under the receiver operating characteristic (ROC) curve (AUC) was significantly greater for the sensitive cTn assays compared with the standard assay (AUC for Roche hs-cTnT, 0.94; Siemens cTnI-Ultra, 0.95; and Abbott-Architect cTnI, 0.95 vs. AUC for the standard assay, 0.90; P < 0.05 for comparisons). The best cut-offs for the sensitive cTn-assays determined by the ROC-curve in elderly patients differed clearly from those in younger patients. Furthermore, the prognostic value regarding 90-day mortality varied among the sensitive cTn assays.CONCLUSION: Sensitive cTn assays have high diagnostic accuracy also in the elderly. Mild elevations are common in elderly non-AMI patients, therefore the optimal cut-off levels are substantially higher in elderly as compared with younger patients. Furthermore, sensitive cTn assays yielded different prognostic value.
AB - AIMS: To examine the diagnostic accuracy of sensitive cardiac troponin (cTn) assays in elderly patients, since elevated levels with sensitive cTn assays were reported in 20% of elderly patients without acute myocardial infarction (AMI).METHODS AND RESULTS: In this multi-centre study, we included 1098 consecutive patients presenting with symptoms suggestive of AMI, 406 (37%) were >70 years old. Measurement of three investigational sensitive cTn assays [Roche high-sensitive cTnT (hs-cTnT), Siemens cTnI-Ultra, and Abbott-Architect cTnI) and the standard assay (Roche cTnT) was performed in a blinded fashion. The final diagnosis was adjudicated by two independent cardiologists. Acute myocardial infarction was the adjudicated final diagnosis in 24% of elderly patients. Among elderly patients without AMI, baseline cTn levels were elevated above the 99th percentile in 51% with Roche hs-cTnT, in 17% with Siemens TnI-Ultra, and 13% with Abbott-Architect cTnI. The diagnostic accuracy as quantified by the area under the receiver operating characteristic (ROC) curve (AUC) was significantly greater for the sensitive cTn assays compared with the standard assay (AUC for Roche hs-cTnT, 0.94; Siemens cTnI-Ultra, 0.95; and Abbott-Architect cTnI, 0.95 vs. AUC for the standard assay, 0.90; P < 0.05 for comparisons). The best cut-offs for the sensitive cTn-assays determined by the ROC-curve in elderly patients differed clearly from those in younger patients. Furthermore, the prognostic value regarding 90-day mortality varied among the sensitive cTn assays.CONCLUSION: Sensitive cTn assays have high diagnostic accuracy also in the elderly. Mild elevations are common in elderly non-AMI patients, therefore the optimal cut-off levels are substantially higher in elderly as compared with younger patients. Furthermore, sensitive cTn assays yielded different prognostic value.
KW - Aged
KW - Aged, 80 and over
KW - Early Diagnosis
KW - Female
KW - Humans
KW - Immunoassay/methods
KW - Male
KW - Myocardial Infarction/diagnosis
KW - Observer Variation
KW - Prospective Studies
KW - ROC Curve
KW - Troponin I/blood
KW - Troponin T/blood
U2 - 10.1093/eurheartj/ehr033
DO - 10.1093/eurheartj/ehr033
M3 - SCORING: Journal article
C2 - 21362702
VL - 32
SP - 1379
EP - 1389
JO - EUR HEART J
JF - EUR HEART J
SN - 0195-668X
IS - 11
ER -