Troponin I Assay for Identification of a Significant Coronary Stenosis in Patients with Suspected Acute Myocardial Infarction and Wide QRS Complex
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Troponin I Assay for Identification of a Significant Coronary Stenosis in Patients with Suspected Acute Myocardial Infarction and Wide QRS Complex. / von Jeinsen, Beatrice; Tzikas, Stergios; Pioro, Gerhard; Palapies, Lars; Zeller, Tanja; Bickel, Christoph; Lackner, Karl J; Baldus, Stephan; Blankenberg, Stefan; Muenzel, Thomas; Zeiher, Andreas M; Keller, Till.
in: PLOS ONE, Jahrgang 11, Nr. 5, 2016, S. e0154724.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Troponin I Assay for Identification of a Significant Coronary Stenosis in Patients with Suspected Acute Myocardial Infarction and Wide QRS Complex
AU - von Jeinsen, Beatrice
AU - Tzikas, Stergios
AU - Pioro, Gerhard
AU - Palapies, Lars
AU - Zeller, Tanja
AU - Bickel, Christoph
AU - Lackner, Karl J
AU - Baldus, Stephan
AU - Blankenberg, Stefan
AU - Muenzel, Thomas
AU - Zeiher, Andreas M
AU - Keller, Till
PY - 2016
Y1 - 2016
N2 - BACKGROUND: Common ECG criteria such as ST-segment changes are of limited value in patients with suspected acute myocardial infarction (AMI) and bundle branch block or wide QRS complex. A large proportion of these patients do not suffer from an AMI, whereas those with ST-elevation myocardial infarction (STEMI) equivalent AMI benefit from an aggressive treatment. Aim of the present study was to evaluate the diagnostic information of cardiac troponin I (cTnI) in hemodynamically stable patients with wide QRS complex and suspected AMI.METHODS: In 417 out of 1818 patients presenting consecutively between 01/2007 and 12/2008 in a prospective multicenter observational study with suspected AMI a prolonged QRS duration was observed. Of these, n = 117 showed significant obstructive coronary artery disease (CAD) used as diagnostic outcome variable. cTnI was determined at admission.RESULTS: Patients with significant CAD had higher cTnI levels compared to individuals without (median 250ng/L vs. 11ng/L; p<0.01). To identify patients needing a coronary intervention, cTnI yielded an area under the receiver operator characteristics curve of 0.849. Optimized cut-offs with respect to a sensitivity driven rule-out and specificity driven rule-in strategy were established (40ng/L/96ng/L). Application of the specificity optimized cut-off value led to a positive predictive value of 71% compared to 59% if using the 99th percentile cut-off. The sensitivity optimized cut-off value was associated with a negative predictive value of 93% compared to 89% provided by application of the 99th percentile threshold.CONCLUSION: cTnI determined in hemodynamically stable patients with suspected AMI and wide QRS complex using optimized diagnostic thresholds improves rule-in and rule-out with respect to presence of a significant obstructive CAD.
AB - BACKGROUND: Common ECG criteria such as ST-segment changes are of limited value in patients with suspected acute myocardial infarction (AMI) and bundle branch block or wide QRS complex. A large proportion of these patients do not suffer from an AMI, whereas those with ST-elevation myocardial infarction (STEMI) equivalent AMI benefit from an aggressive treatment. Aim of the present study was to evaluate the diagnostic information of cardiac troponin I (cTnI) in hemodynamically stable patients with wide QRS complex and suspected AMI.METHODS: In 417 out of 1818 patients presenting consecutively between 01/2007 and 12/2008 in a prospective multicenter observational study with suspected AMI a prolonged QRS duration was observed. Of these, n = 117 showed significant obstructive coronary artery disease (CAD) used as diagnostic outcome variable. cTnI was determined at admission.RESULTS: Patients with significant CAD had higher cTnI levels compared to individuals without (median 250ng/L vs. 11ng/L; p<0.01). To identify patients needing a coronary intervention, cTnI yielded an area under the receiver operator characteristics curve of 0.849. Optimized cut-offs with respect to a sensitivity driven rule-out and specificity driven rule-in strategy were established (40ng/L/96ng/L). Application of the specificity optimized cut-off value led to a positive predictive value of 71% compared to 59% if using the 99th percentile cut-off. The sensitivity optimized cut-off value was associated with a negative predictive value of 93% compared to 89% provided by application of the 99th percentile threshold.CONCLUSION: cTnI determined in hemodynamically stable patients with suspected AMI and wide QRS complex using optimized diagnostic thresholds improves rule-in and rule-out with respect to presence of a significant obstructive CAD.
KW - Aged
KW - Algorithms
KW - Biomarkers/blood
KW - Coronary Stenosis/complications
KW - Electrocardiography
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/complications
KW - Patient Admission
KW - Sensitivity and Specificity
KW - Troponin I/blood
U2 - 10.1371/journal.pone.0154724
DO - 10.1371/journal.pone.0154724
M3 - SCORING: Journal article
C2 - 27148734
VL - 11
SP - e0154724
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 5
ER -
