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Early diagnosis of acute myocardial infarction in the elderly using more sensitive cardiac troponin assays

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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, Vol. 32, No. 11, 06.2011, p. 1379-89.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Reiter, M, Twerenbold, R, Reichlin, T, Haaf, P, Peter, F, Meissner, J, Hochholzer, W, Stelzig, C, Freese, M, Heinisch, C, Breidthardt, T, Freidank, H, Winkler, K, Campodarve, I, Gea, J & Mueller, C 2011, 'Early diagnosis of acute myocardial infarction in the elderly using more sensitive cardiac troponin assays', EUR HEART J, vol. 32, no. 11, pp. 1379-89. https://doi.org/10.1093/eurheartj/ehr033

APA

Reiter, M., Twerenbold, R., Reichlin, T., Haaf, P., Peter, F., Meissner, J., Hochholzer, W., Stelzig, C., Freese, M., Heinisch, C., Breidthardt, T., Freidank, H., Winkler, K., Campodarve, I., Gea, J., & Mueller, C. (2011). Early diagnosis of acute myocardial infarction in the elderly using more sensitive cardiac troponin assays. EUR HEART J, 32(11), 1379-89. https://doi.org/10.1093/eurheartj/ehr033

Vancouver

Reiter M, Twerenbold R, Reichlin T, Haaf P, Peter F, Meissner J et al. Early diagnosis of acute myocardial infarction in the elderly using more sensitive cardiac troponin assays. EUR HEART J. 2011 Jun;32(11):1379-89. https://doi.org/10.1093/eurheartj/ehr033

Bibtex

@article{83d5de4991124631aa0558ba2c83d21e,
title = "Early diagnosis of acute myocardial infarction in the elderly using more sensitive cardiac troponin assays",
abstract = "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.",
keywords = "Aged, Aged, 80 and over, Early Diagnosis, Female, Humans, Immunoassay/methods, Male, Myocardial Infarction/diagnosis, Observer Variation, Prospective Studies, ROC Curve, Troponin I/blood, Troponin T/blood",
author = "Miriam Reiter and Raphael Twerenbold and Tobias Reichlin and Philip Haaf and Frederico Peter and Julia Meissner and Willibald Hochholzer and Claudia Stelzig and Michael Freese and Corinna Heinisch and Tobias Breidthardt and Heike Freidank and Katrin Winkler and Isabel Campodarve and Joaquim Gea and Christian Mueller",
year = "2011",
month = jun,
doi = "10.1093/eurheartj/ehr033",
language = "English",
volume = "32",
pages = "1379--89",
journal = "EUR HEART J",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "11",

}

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 -