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Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay

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Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay. / Liebetrau, Christoph; Weber, Michael; Tzikas, Stergios; Palapies, Lars; Möllmann, Helge; Pioro, Gerhard; Zeller, Tanja; Beiras-Fernandez, Andres; Bickel, Christoph; Zeiher, Andreas M; Lackner, Karl J; Baldus, Stephan; Nef, Holger M; Blankenberg, Stefan; Hamm, Christian W; Münzel, Thomas; Keller, Till.

In: BMC MED, Vol. 13, 27.07.2015, p. 169.

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

Harvard

Liebetrau, C, Weber, M, Tzikas, S, Palapies, L, Möllmann, H, Pioro, G, Zeller, T, Beiras-Fernandez, A, Bickel, C, Zeiher, AM, Lackner, KJ, Baldus, S, Nef, HM, Blankenberg, S, Hamm, CW, Münzel, T & Keller, T 2015, 'Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay', BMC MED, vol. 13, pp. 169. https://doi.org/10.1186/s12916-015-0410-8

APA

Liebetrau, C., Weber, M., Tzikas, S., Palapies, L., Möllmann, H., Pioro, G., Zeller, T., Beiras-Fernandez, A., Bickel, C., Zeiher, A. M., Lackner, K. J., Baldus, S., Nef, H. M., Blankenberg, S., Hamm, C. W., Münzel, T., & Keller, T. (2015). Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay. BMC MED, 13, 169. https://doi.org/10.1186/s12916-015-0410-8

Vancouver

Liebetrau C, Weber M, Tzikas S, Palapies L, Möllmann H, Pioro G et al. Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay. BMC MED. 2015 Jul 27;13:169. https://doi.org/10.1186/s12916-015-0410-8

Bibtex

@article{3cae6796cb5741f193e73aa186527151,
title = "Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay",
abstract = "BACKGROUND: The introduction of modern troponin assays has facilitated diagnosis of acute myocardial infarction due to improved sensitivity with corresponding loss of specificity. Atrial fibrillation (AF) is associated with elevated levels of troponin. The aim of the present study was to evaluate the diagnostic performance of troponin I in patients with suspected acute coronary syndrome and chronic AF.METHODS: Contemporary sensitive troponin I was assayed in a derivation cohort of 90 patients with suspected acute coronary syndrome and chronic AF to establish diagnostic cut-offs. These thresholds were validated in an independent cohort of 314 patients with suspected myocardial infarction and AF upon presentation. Additionally, changes in troponin I concentration within 3 hours were used.RESULTS: In the derivation cohort, optimized thresholds with respect to a rule-out strategy with high sensitivity and a rule-in strategy with high specificity were established. In the validation cohort, application of the rule-out cut-off led to a negative predictive value of 97 %. The rule-in cut-off was associated with a positive predictive value of 88 % compared with 71 % if using the 99th percentile cut-off. In patients with troponin I levels above the specificity-optimized threshold, additional use of the 3-hour change in absolute/relative concentration resulted in a further improved positive predictive value of 96 %/100 %.CONCLUSIONS: Troponin I concentration and the 3-hour change in its concentration provide valid diagnostic information in patients with suspected myocardial infarction and chronic AF. With regard to AF-associated elevation of troponin levels, application of diagnostic cut-offs other than the 99th percentile might be beneficial.",
keywords = "Aged, Atrial Fibrillation/complications, Biomarkers/blood, Chest Pain/etiology, Female, Humans, Male, Middle Aged, Myocardial Infarction/blood, Predictive Value of Tests, Reference Values, Troponin I/blood",
author = "Christoph Liebetrau and Michael Weber and Stergios Tzikas and Lars Palapies and Helge M{\"o}llmann and Gerhard Pioro and Tanja Zeller and Andres Beiras-Fernandez and Christoph Bickel and Zeiher, {Andreas M} and Lackner, {Karl J} and Stephan Baldus and Nef, {Holger M} and Stefan Blankenberg and Hamm, {Christian W} and Thomas M{\"u}nzel and Till Keller",
year = "2015",
month = jul,
day = "27",
doi = "10.1186/s12916-015-0410-8",
language = "English",
volume = "13",
pages = "169",
journal = "BMC MED",
issn = "1741-7015",
publisher = "BioMed Central Ltd.",

}

RIS

TY - JOUR

T1 - Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay

AU - Liebetrau, Christoph

AU - Weber, Michael

AU - Tzikas, Stergios

AU - Palapies, Lars

AU - Möllmann, Helge

AU - Pioro, Gerhard

AU - Zeller, Tanja

AU - Beiras-Fernandez, Andres

AU - Bickel, Christoph

AU - Zeiher, Andreas M

AU - Lackner, Karl J

AU - Baldus, Stephan

AU - Nef, Holger M

AU - Blankenberg, Stefan

AU - Hamm, Christian W

AU - Münzel, Thomas

AU - Keller, Till

PY - 2015/7/27

Y1 - 2015/7/27

N2 - BACKGROUND: The introduction of modern troponin assays has facilitated diagnosis of acute myocardial infarction due to improved sensitivity with corresponding loss of specificity. Atrial fibrillation (AF) is associated with elevated levels of troponin. The aim of the present study was to evaluate the diagnostic performance of troponin I in patients with suspected acute coronary syndrome and chronic AF.METHODS: Contemporary sensitive troponin I was assayed in a derivation cohort of 90 patients with suspected acute coronary syndrome and chronic AF to establish diagnostic cut-offs. These thresholds were validated in an independent cohort of 314 patients with suspected myocardial infarction and AF upon presentation. Additionally, changes in troponin I concentration within 3 hours were used.RESULTS: In the derivation cohort, optimized thresholds with respect to a rule-out strategy with high sensitivity and a rule-in strategy with high specificity were established. In the validation cohort, application of the rule-out cut-off led to a negative predictive value of 97 %. The rule-in cut-off was associated with a positive predictive value of 88 % compared with 71 % if using the 99th percentile cut-off. In patients with troponin I levels above the specificity-optimized threshold, additional use of the 3-hour change in absolute/relative concentration resulted in a further improved positive predictive value of 96 %/100 %.CONCLUSIONS: Troponin I concentration and the 3-hour change in its concentration provide valid diagnostic information in patients with suspected myocardial infarction and chronic AF. With regard to AF-associated elevation of troponin levels, application of diagnostic cut-offs other than the 99th percentile might be beneficial.

AB - BACKGROUND: The introduction of modern troponin assays has facilitated diagnosis of acute myocardial infarction due to improved sensitivity with corresponding loss of specificity. Atrial fibrillation (AF) is associated with elevated levels of troponin. The aim of the present study was to evaluate the diagnostic performance of troponin I in patients with suspected acute coronary syndrome and chronic AF.METHODS: Contemporary sensitive troponin I was assayed in a derivation cohort of 90 patients with suspected acute coronary syndrome and chronic AF to establish diagnostic cut-offs. These thresholds were validated in an independent cohort of 314 patients with suspected myocardial infarction and AF upon presentation. Additionally, changes in troponin I concentration within 3 hours were used.RESULTS: In the derivation cohort, optimized thresholds with respect to a rule-out strategy with high sensitivity and a rule-in strategy with high specificity were established. In the validation cohort, application of the rule-out cut-off led to a negative predictive value of 97 %. The rule-in cut-off was associated with a positive predictive value of 88 % compared with 71 % if using the 99th percentile cut-off. In patients with troponin I levels above the specificity-optimized threshold, additional use of the 3-hour change in absolute/relative concentration resulted in a further improved positive predictive value of 96 %/100 %.CONCLUSIONS: Troponin I concentration and the 3-hour change in its concentration provide valid diagnostic information in patients with suspected myocardial infarction and chronic AF. With regard to AF-associated elevation of troponin levels, application of diagnostic cut-offs other than the 99th percentile might be beneficial.

KW - Aged

KW - Atrial Fibrillation/complications

KW - Biomarkers/blood

KW - Chest Pain/etiology

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/blood

KW - Predictive Value of Tests

KW - Reference Values

KW - Troponin I/blood

U2 - 10.1186/s12916-015-0410-8

DO - 10.1186/s12916-015-0410-8

M3 - SCORING: Journal article

C2 - 26212559

VL - 13

SP - 169

JO - BMC MED

JF - BMC MED

SN - 1741-7015

ER -