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Early diagnosis of acute myocardial infarction using high-sensitivity troponin I

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Early diagnosis of acute myocardial infarction using high-sensitivity troponin I. / Neumann, Johannes Tobias; Sörensen, Nils Arne; Ojeda, Francisco; Renné, Thomas; Schnabel, Renate B; Zeller, Tanja; Karakas, Mahir; Blankenberg, Stefan; Westermann, Dirk.

In: PLOS ONE, Vol. 12, No. 3, 2017, p. e0174288.

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

Harvard

Neumann, JT, Sörensen, NA, Ojeda, F, Renné, T, Schnabel, RB, Zeller, T, Karakas, M, Blankenberg, S & Westermann, D 2017, 'Early diagnosis of acute myocardial infarction using high-sensitivity troponin I', PLOS ONE, vol. 12, no. 3, pp. e0174288. https://doi.org/10.1371/journal.pone.0174288

APA

Neumann, J. T., Sörensen, N. A., Ojeda, F., Renné, T., Schnabel, R. B., Zeller, T., Karakas, M., Blankenberg, S., & Westermann, D. (2017). Early diagnosis of acute myocardial infarction using high-sensitivity troponin I. PLOS ONE, 12(3), e0174288. https://doi.org/10.1371/journal.pone.0174288

Vancouver

Neumann JT, Sörensen NA, Ojeda F, Renné T, Schnabel RB, Zeller T et al. Early diagnosis of acute myocardial infarction using high-sensitivity troponin I. PLOS ONE. 2017;12(3):e0174288. https://doi.org/10.1371/journal.pone.0174288

Bibtex

@article{2c89656de5c14f6f9f2d0180561e71dd,
title = "Early diagnosis of acute myocardial infarction using high-sensitivity troponin I",
abstract = "OBJECTIVE: There is a clinical need for early and accurate diagnosis of acute myocardial infarction (AMI). Current European Society of Cardiology (ESC) guidelines recommend diagnosis of non-ST-elevation AMI based on serial troponin measurements. We aimed to challenge the ESC guidelines using 1) a high-sensitivity troponin I (hs-TnI) baseline cutoff, 2) an absolute hs-TnI change after 1 hour and 3) additional application of an ischemic ECG.METHODS: 1,516 patients with suspected AMI presenting to the emergency department were included. Hs-TnI was measured directly at admission, after 1 and 3 hours. We investigated baseline concentrations, absolute changes of hs-TnI and additional application of an ischemic ECG to diagnose AMI. A positive predictive value (PPV) of more than 85% was targeted.RESULTS: The median age of the study population was 65 years; 291 patients were diagnosed with AMI. The PPV of the 3-hours ESC algorithm was 85.5% (CI 79.7, 90.1) and 65.8% (CI 60.5,70.8) for the 1-hour algorithm. Using a high baseline hs-TnI concentration of 150 ng/L resulted in a PPV of 87.8% (CI 80.9,92.9). Alternatively, a hs-TnI change of 20 ng/L after 1 hour, resulted in a PPV of 86.5% (80.9,91.0), respectively for the diagnosis of AMI. Additional use of an ischemic ECG increased the PPV to 90.5% (CI 83.2,95.3), while reducing the efficacy.CONCLUSION: The diagnosis of AMI based on hs-TnI is challenging. The application of absolute hs-TnI changes after 1 hour may facilitate rapid rule-in of patients.TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02355457).",
keywords = "Journal Article",
author = "Neumann, {Johannes Tobias} and S{\"o}rensen, {Nils Arne} and Francisco Ojeda and Thomas Renn{\'e} and Schnabel, {Renate B} and Tanja Zeller and Mahir Karakas and Stefan Blankenberg and Dirk Westermann",
year = "2017",
doi = "10.1371/journal.pone.0174288",
language = "English",
volume = "12",
pages = "e0174288",
journal = "PLOS ONE",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "3",

}

RIS

TY - JOUR

T1 - Early diagnosis of acute myocardial infarction using high-sensitivity troponin I

AU - Neumann, Johannes Tobias

AU - Sörensen, Nils Arne

AU - Ojeda, Francisco

AU - Renné, Thomas

AU - Schnabel, Renate B

AU - Zeller, Tanja

AU - Karakas, Mahir

AU - Blankenberg, Stefan

AU - Westermann, Dirk

PY - 2017

Y1 - 2017

N2 - OBJECTIVE: There is a clinical need for early and accurate diagnosis of acute myocardial infarction (AMI). Current European Society of Cardiology (ESC) guidelines recommend diagnosis of non-ST-elevation AMI based on serial troponin measurements. We aimed to challenge the ESC guidelines using 1) a high-sensitivity troponin I (hs-TnI) baseline cutoff, 2) an absolute hs-TnI change after 1 hour and 3) additional application of an ischemic ECG.METHODS: 1,516 patients with suspected AMI presenting to the emergency department were included. Hs-TnI was measured directly at admission, after 1 and 3 hours. We investigated baseline concentrations, absolute changes of hs-TnI and additional application of an ischemic ECG to diagnose AMI. A positive predictive value (PPV) of more than 85% was targeted.RESULTS: The median age of the study population was 65 years; 291 patients were diagnosed with AMI. The PPV of the 3-hours ESC algorithm was 85.5% (CI 79.7, 90.1) and 65.8% (CI 60.5,70.8) for the 1-hour algorithm. Using a high baseline hs-TnI concentration of 150 ng/L resulted in a PPV of 87.8% (CI 80.9,92.9). Alternatively, a hs-TnI change of 20 ng/L after 1 hour, resulted in a PPV of 86.5% (80.9,91.0), respectively for the diagnosis of AMI. Additional use of an ischemic ECG increased the PPV to 90.5% (CI 83.2,95.3), while reducing the efficacy.CONCLUSION: The diagnosis of AMI based on hs-TnI is challenging. The application of absolute hs-TnI changes after 1 hour may facilitate rapid rule-in of patients.TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02355457).

AB - OBJECTIVE: There is a clinical need for early and accurate diagnosis of acute myocardial infarction (AMI). Current European Society of Cardiology (ESC) guidelines recommend diagnosis of non-ST-elevation AMI based on serial troponin measurements. We aimed to challenge the ESC guidelines using 1) a high-sensitivity troponin I (hs-TnI) baseline cutoff, 2) an absolute hs-TnI change after 1 hour and 3) additional application of an ischemic ECG.METHODS: 1,516 patients with suspected AMI presenting to the emergency department were included. Hs-TnI was measured directly at admission, after 1 and 3 hours. We investigated baseline concentrations, absolute changes of hs-TnI and additional application of an ischemic ECG to diagnose AMI. A positive predictive value (PPV) of more than 85% was targeted.RESULTS: The median age of the study population was 65 years; 291 patients were diagnosed with AMI. The PPV of the 3-hours ESC algorithm was 85.5% (CI 79.7, 90.1) and 65.8% (CI 60.5,70.8) for the 1-hour algorithm. Using a high baseline hs-TnI concentration of 150 ng/L resulted in a PPV of 87.8% (CI 80.9,92.9). Alternatively, a hs-TnI change of 20 ng/L after 1 hour, resulted in a PPV of 86.5% (80.9,91.0), respectively for the diagnosis of AMI. Additional use of an ischemic ECG increased the PPV to 90.5% (CI 83.2,95.3), while reducing the efficacy.CONCLUSION: The diagnosis of AMI based on hs-TnI is challenging. The application of absolute hs-TnI changes after 1 hour may facilitate rapid rule-in of patients.TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02355457).

KW - Journal Article

U2 - 10.1371/journal.pone.0174288

DO - 10.1371/journal.pone.0174288

M3 - SCORING: Journal article

C2 - 28333976

VL - 12

SP - e0174288

JO - PLOS ONE

JF - PLOS ONE

SN - 1932-6203

IS - 3

ER -