Identification of acute myocardial infarction in elderly patients using optimized highly sensitive troponin I thresholds
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Identification of acute myocardial infarction in elderly patients using optimized highly sensitive troponin I thresholds. / von Jeinsen, Beatrice; Liebetrau, Christoph; Palapies, Lars; Tzikas, Stergios; Zeller, Tanja; Bickel, Christoph; Schmidt, Alexander; Tubaro, Marco; Lackner, Karl J; Sar, Fachrie; Baldus, Stephan; Zeiher, Andreas M; Blankenberg, Stefan; Gori, Tommaso; Münzel, Thomas; Hamm, Christian W; Wild, Philipp S; Keller, Till.
in: BIOMARKERS, Jahrgang 24, Nr. 6, 09.2019, S. 549-555.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Identification of acute myocardial infarction in elderly patients using optimized highly sensitive troponin I thresholds
AU - von Jeinsen, Beatrice
AU - Liebetrau, Christoph
AU - Palapies, Lars
AU - Tzikas, Stergios
AU - Zeller, Tanja
AU - Bickel, Christoph
AU - Schmidt, Alexander
AU - Tubaro, Marco
AU - Lackner, Karl J
AU - Sar, Fachrie
AU - Baldus, Stephan
AU - Zeiher, Andreas M
AU - Blankenberg, Stefan
AU - Gori, Tommaso
AU - Münzel, Thomas
AU - Hamm, Christian W
AU - Wild, Philipp S
AU - Keller, Till
PY - 2019/9
Y1 - 2019/9
N2 - Purpose: Established diagnostic thresholds for high-sensitivity cardiac troponins (hs-cTn) might not apply for elderly patients as they are elevated irrespective of the presence of an acute myocardial infarction (AMI). Aim of the present study was to investigate hs-cTnI in elderly patients with suspected AMI and to calculate optimized diagnostic cutoffs. Material and methods: Data from a prospective multi-centre study and from a second independent prospective single-centre cohort study were analysed. A number of 2903 patients were eligible for further analysis. Patients > 70 years were classified as elderly. hs-cTnI was measured upon admission. Results: Around 34.7% of 2903 patients were classified as elderly. Around 22.5% of elderly patients were finally diagnosed with AMI. Elderly patients had higher hs-cTnI levels at admission irrespective of the final diagnosis (p < 0.001). According to the AUROC, hs-cTnI was a strong marker for detection of AMI in elderly patients. Application of the 99th percentile cutoffs showed a substantially lower specificity in elderly. By using optimized thresholds, specificity was improved to levels as in younger patients in both cohorts but accompanied with a decrease in sensitivity. Conclusions: hs-cTnI levels have a lower specificity for detecting AMI in elderly patients. This lower specificity can be improved by using hs-cTnI thresholds optimized for elderly patients.
AB - Purpose: Established diagnostic thresholds for high-sensitivity cardiac troponins (hs-cTn) might not apply for elderly patients as they are elevated irrespective of the presence of an acute myocardial infarction (AMI). Aim of the present study was to investigate hs-cTnI in elderly patients with suspected AMI and to calculate optimized diagnostic cutoffs. Material and methods: Data from a prospective multi-centre study and from a second independent prospective single-centre cohort study were analysed. A number of 2903 patients were eligible for further analysis. Patients > 70 years were classified as elderly. hs-cTnI was measured upon admission. Results: Around 34.7% of 2903 patients were classified as elderly. Around 22.5% of elderly patients were finally diagnosed with AMI. Elderly patients had higher hs-cTnI levels at admission irrespective of the final diagnosis (p < 0.001). According to the AUROC, hs-cTnI was a strong marker for detection of AMI in elderly patients. Application of the 99th percentile cutoffs showed a substantially lower specificity in elderly. By using optimized thresholds, specificity was improved to levels as in younger patients in both cohorts but accompanied with a decrease in sensitivity. Conclusions: hs-cTnI levels have a lower specificity for detecting AMI in elderly patients. This lower specificity can be improved by using hs-cTnI thresholds optimized for elderly patients.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Biomarkers/blood
KW - Female
KW - Humans
KW - Hyperlipidemias/blood
KW - Hypertension/blood
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/blood
KW - Prospective Studies
KW - Risk Factors
KW - Sensitivity and Specificity
KW - Smoking/blood
KW - Troponin I/blood
U2 - 10.1080/1354750X.2019.1606276
DO - 10.1080/1354750X.2019.1606276
M3 - SCORING: Journal article
C2 - 31159594
VL - 24
SP - 549
EP - 555
JO - BIOMARKERS
JF - BIOMARKERS
SN - 1354-750X
IS - 6
ER -