Sensitive troponin I assay in early diagnosis of acute myocardial infarction
Standard
Sensitive troponin I assay in early diagnosis of acute myocardial infarction. / Keller, Till; Zeller, Tanja; Peetz, Dirk; Tzikas, Stergios; Roth, Alexander; Czyz, Ewa; Bickel, Christoph; Baldus, Stephan; Warnholtz, Ascan; Fröhlich, Meike; Sinning, Christoph R; Eleftheriadis, Medea S; Wild, Philipp S; Schnabel, Renate B; Lubos, Edith; Jachmann, Nicole; Genth-Zotz, Sabine; Post, Felix; Nicaud, Viviane; Tiret, Laurence; Lackner, Karl J; Münzel, Thomas F; Blankenberg, Stefan.
in: NEW ENGL J MED, Jahrgang 361, Nr. 9, 27.08.2009, S. 868-877.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Sensitive troponin I assay in early diagnosis of acute myocardial infarction
AU - Keller, Till
AU - Zeller, Tanja
AU - Peetz, Dirk
AU - Tzikas, Stergios
AU - Roth, Alexander
AU - Czyz, Ewa
AU - Bickel, Christoph
AU - Baldus, Stephan
AU - Warnholtz, Ascan
AU - Fröhlich, Meike
AU - Sinning, Christoph R
AU - Eleftheriadis, Medea S
AU - Wild, Philipp S
AU - Schnabel, Renate B
AU - Lubos, Edith
AU - Jachmann, Nicole
AU - Genth-Zotz, Sabine
AU - Post, Felix
AU - Nicaud, Viviane
AU - Tiret, Laurence
AU - Lackner, Karl J
AU - Münzel, Thomas F
AU - Blankenberg, Stefan
N1 - 2009 Massachusetts Medical Society
PY - 2009/8/27
Y1 - 2009/8/27
N2 - BACKGROUND: Cardiac troponin testing is central to the diagnosis of acute myocardial infarction. We evaluated a sensitive troponin I assay for the early diagnosis and risk stratification of myocardial infarction.METHODS: In a multicenter study, we determined levels of troponin I as assessed by a sensitive assay, troponin T, and traditional myocardial necrosis markers in 1818 consecutive patients with suspected acute myocardial infarction, on admission and 3 hours and 6 hours after admission.RESULTS: For samples obtained on admission, the diagnostic accuracy was highest with the sensitive troponin I assay (area under the receiver-operating-characteristic curve [AUC], 0.96), as compared with the troponin T assay (AUC, 0.85) and traditional myocardial necrosis markers. With the use of the sensitive troponin I assay (cutoff value, 0.04 ng per milliliter) on admission, the clinical sensitivity was 90.7%, and the specificity was 90.2%. The diagnostic accuracy was virtually identical in baseline and serial samples, regardless of the time of chest-pain onset. In patients presenting within 3 hours after chest-pain onset, a single sensitive troponin I assay had a negative predictive value of 84.1% and a positive predictive value of 86.7%; these findings predicted a 30% rise in the troponin I level within 6 hours. A troponin I level of more than 0.04 ng per milliliter was independently associated with an increased risk of an adverse outcome at 30 days (hazard ratio, 1.96; 95% confidence interval, 1.27 to 3.05; P=0.003).CONCLUSIONS: The use of a sensitive assay for troponin I improves early diagnosis of acute myocardial infarction and risk stratification, regardless of the time of chest-pain onset.
AB - BACKGROUND: Cardiac troponin testing is central to the diagnosis of acute myocardial infarction. We evaluated a sensitive troponin I assay for the early diagnosis and risk stratification of myocardial infarction.METHODS: In a multicenter study, we determined levels of troponin I as assessed by a sensitive assay, troponin T, and traditional myocardial necrosis markers in 1818 consecutive patients with suspected acute myocardial infarction, on admission and 3 hours and 6 hours after admission.RESULTS: For samples obtained on admission, the diagnostic accuracy was highest with the sensitive troponin I assay (area under the receiver-operating-characteristic curve [AUC], 0.96), as compared with the troponin T assay (AUC, 0.85) and traditional myocardial necrosis markers. With the use of the sensitive troponin I assay (cutoff value, 0.04 ng per milliliter) on admission, the clinical sensitivity was 90.7%, and the specificity was 90.2%. The diagnostic accuracy was virtually identical in baseline and serial samples, regardless of the time of chest-pain onset. In patients presenting within 3 hours after chest-pain onset, a single sensitive troponin I assay had a negative predictive value of 84.1% and a positive predictive value of 86.7%; these findings predicted a 30% rise in the troponin I level within 6 hours. A troponin I level of more than 0.04 ng per milliliter was independently associated with an increased risk of an adverse outcome at 30 days (hazard ratio, 1.96; 95% confidence interval, 1.27 to 3.05; P=0.003).CONCLUSIONS: The use of a sensitive assay for troponin I improves early diagnosis of acute myocardial infarction and risk stratification, regardless of the time of chest-pain onset.
KW - Aged
KW - Angina, Unstable/blood
KW - Area Under Curve
KW - Biomarkers/blood
KW - Chest Pain/etiology
KW - Comorbidity
KW - Early Diagnosis
KW - Electrocardiography
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/blood
KW - Predictive Value of Tests
KW - ROC Curve
KW - Sensitivity and Specificity
KW - Troponin I/blood
KW - Troponin T/blood
U2 - 10.1056/NEJMoa0903515
DO - 10.1056/NEJMoa0903515
M3 - SCORING: Journal article
C2 - 19710485
VL - 361
SP - 868
EP - 877
JO - NEW ENGL J MED
JF - NEW ENGL J MED
SN - 0028-4793
IS - 9
ER -