The association of anaemia and high-sensitivity cardiac troponin and its effect on diagnosing myocardial infarction
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The association of anaemia and high-sensitivity cardiac troponin and its effect on diagnosing myocardial infarction. / Haller, Paul Michael; Neumann, Johannes T; Sörensen, Nils A; Hartikainen, Tau S; Goßling, Alina; Lehmacher, Jonas; Keller, Till; Zeller, Tanja; Blankenberg, Stefan; Westermann, Dirk.
in: EUR HEART J-ACUTE CA, Jahrgang 10, Nr. 10, 18.12.2021, S. 1187-1196.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - The association of anaemia and high-sensitivity cardiac troponin and its effect on diagnosing myocardial infarction
AU - Haller, Paul Michael
AU - Neumann, Johannes T
AU - Sörensen, Nils A
AU - Hartikainen, Tau S
AU - Goßling, Alina
AU - Lehmacher, Jonas
AU - Keller, Till
AU - Zeller, Tanja
AU - Blankenberg, Stefan
AU - Westermann, Dirk
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
PY - 2021/12/18
Y1 - 2021/12/18
N2 - AIMS: Anaemia is common in patients with acute myocardial infarction (MI). We investigated the association of high-sensitivity cardiac troponin (hs-cTn) and haemoglobin (Hb) and the influence of anaemia on the performance of diagnostic protocols for suspected MI.METHODS AND RESULTS: Patients with suspected MI were consecutively enrolled at a tertiary centre. Final diagnoses were independently adjudicated by two cardiologists. Performance measures of hs-cTn-based algorithms were compared for anaemic and non-anaemic patients (Hb <12 g/dL in women and <13 g/dL in men). The influence of anaemia on survival (median follow-up 1.7 years) was investigated using multivariable cox-regression analysis and the association of Hb and hs-cTn by multivariable linear regression analysis. Overall, 2223 patients were included, of whom 415 (18.7%) had anaemia. In anaemic patients, the incidence of MI was similar; however, chronic myocardial injury was significantly more prevalent (20.1% vs. 48.2%). The negative predictive value to rule-out MI was similar for both algorithms and all assays in patients with anaemia, although the positive predictive value to rule-in MI was partly reduced for the 0/3-h algorithm. Fewer anaemic patients were triaged after 1 h. Anaemia was an independent predictor of death. Adjusted for patient characteristics, Hb was significantly associated with hs-cTn. By providing a point-based tool, the Hb-associated hs-cTn concentration and thus chronic myocardial injury may be predicted.CONCLUSION : Anaemia partly affects the rule-in, but not the rule-out of MI in hs-cTn-based diagnostic protocols. Hs-cTn concentrations and thus chronic myocardial injury may be predicted by clinical variables and Hb.TRIAL REGISTRATION: clinicaltrials.gov (NCT02355457 and NCT03227159).
AB - AIMS: Anaemia is common in patients with acute myocardial infarction (MI). We investigated the association of high-sensitivity cardiac troponin (hs-cTn) and haemoglobin (Hb) and the influence of anaemia on the performance of diagnostic protocols for suspected MI.METHODS AND RESULTS: Patients with suspected MI were consecutively enrolled at a tertiary centre. Final diagnoses were independently adjudicated by two cardiologists. Performance measures of hs-cTn-based algorithms were compared for anaemic and non-anaemic patients (Hb <12 g/dL in women and <13 g/dL in men). The influence of anaemia on survival (median follow-up 1.7 years) was investigated using multivariable cox-regression analysis and the association of Hb and hs-cTn by multivariable linear regression analysis. Overall, 2223 patients were included, of whom 415 (18.7%) had anaemia. In anaemic patients, the incidence of MI was similar; however, chronic myocardial injury was significantly more prevalent (20.1% vs. 48.2%). The negative predictive value to rule-out MI was similar for both algorithms and all assays in patients with anaemia, although the positive predictive value to rule-in MI was partly reduced for the 0/3-h algorithm. Fewer anaemic patients were triaged after 1 h. Anaemia was an independent predictor of death. Adjusted for patient characteristics, Hb was significantly associated with hs-cTn. By providing a point-based tool, the Hb-associated hs-cTn concentration and thus chronic myocardial injury may be predicted.CONCLUSION : Anaemia partly affects the rule-in, but not the rule-out of MI in hs-cTn-based diagnostic protocols. Hs-cTn concentrations and thus chronic myocardial injury may be predicted by clinical variables and Hb.TRIAL REGISTRATION: clinicaltrials.gov (NCT02355457 and NCT03227159).
U2 - 10.1093/ehjacc/zuab066
DO - 10.1093/ehjacc/zuab066
M3 - SCORING: Journal article
C2 - 34350455
VL - 10
SP - 1187
EP - 1196
JO - EUR HEART J-ACUTE CA
JF - EUR HEART J-ACUTE CA
SN - 2048-8726
IS - 10
ER -