Normal presenting levels of high-sensitivity troponin and myocardial infarction
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Normal presenting levels of high-sensitivity troponin and myocardial infarction. / Hoeller, Rebeca; Giménez, María Rubini; Reichlin, Tobias; Twerenbold, Raphael; Zellweger, Christa; Moehring, Berit; Wildi, Karin; Freese, Michael; Stelzig, Claudia; Hartmann, Beate; Stoll, Melanie; Mosimann, Tamina; Reiter, Miriam; Haaf, Philip; Mueller, Mira; Meller, Bernadette; Hochgruber, Thomas; Balmelli, Cathrin; Sou, Seoung Mann; Murray, Karsten; Freidank, Heike; Steuer, Stephan; Minners, Jan; Osswald, Stefan; Mueller, Christian.
In: HEART, Vol. 99, No. 21, 11.2013, p. 1567-1572.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Normal presenting levels of high-sensitivity troponin and myocardial infarction
AU - Hoeller, Rebeca
AU - Giménez, María Rubini
AU - Reichlin, Tobias
AU - Twerenbold, Raphael
AU - Zellweger, Christa
AU - Moehring, Berit
AU - Wildi, Karin
AU - Freese, Michael
AU - Stelzig, Claudia
AU - Hartmann, Beate
AU - Stoll, Melanie
AU - Mosimann, Tamina
AU - Reiter, Miriam
AU - Haaf, Philip
AU - Mueller, Mira
AU - Meller, Bernadette
AU - Hochgruber, Thomas
AU - Balmelli, Cathrin
AU - Sou, Seoung Mann
AU - Murray, Karsten
AU - Freidank, Heike
AU - Steuer, Stephan
AU - Minners, Jan
AU - Osswald, Stefan
AU - Mueller, Christian
PY - 2013/11
Y1 - 2013/11
N2 - Objective To analyse whether levels of high-sensitivity cardiac troponin (hs-cTn) below their respective 99th percentile can be used as a single parameter to rule out acute myocardial infarction (AMI) at presentation. Design Prospective, multicentre study. Main outcome measures We measured hs-cTn using four different methods (hs-cTnT Roche, hs-cTnI Siemens, hs-cTnI Beckman Coulter and hs-cTnI Abbott) in consecutive patients presenting to the emergency department with acute chest pain. Two independent cardiologists adjudicated the final diagnosis. Patients were followed for death or AMI during a mean period of 24 months. Results Among 2072 consecutive patients with hs-cTnT measurements available, 21.4% had an adjudicated diagnosis of AMI (sensitivity 89.6%, 95% CI 86.4% to 92.3%, negative predictive value (NPV): 96.5%, 95% CI 95.4% to 97.4%). Among 1180 consecutive patients with hs-cTnI Siemens measurements available, 20.0% had AMI (sensitivity 94.1%, 95% CI 90.3% to 96.7%, NPV: 98.0%, 95% CI: 96.6% to 98.9%). Among 1151 consecutive patients with hs-cTnI Beckman Coulter measurements available, 19.7% had AMI (sensitivity 92.1%, 95% CI 87.8% to 95.2%, NPV: 97.5%, 95% CI 96.0% to 98.5%). Among 1567 consecutive patients with hs-cTnI Abbott measurements available, 20.0% had AMI (sensitivity 77.2%, 95% CI 72.1% to 81.7%, NPV: 94.3%, 95% CI 92.8% to 95.5%). Conclusions Normal hs-cTn levels at presentation should not be used as a single parameter to rule out AMI as 6%-23% of adjudicated AMI cases had normal levels of hs-cTn levels at presentation. Our data highlight the lack of standardisation among hs-cTnI assays resulting in substantial differences in sensitivity and NPV at the 99th percentile.
AB - Objective To analyse whether levels of high-sensitivity cardiac troponin (hs-cTn) below their respective 99th percentile can be used as a single parameter to rule out acute myocardial infarction (AMI) at presentation. Design Prospective, multicentre study. Main outcome measures We measured hs-cTn using four different methods (hs-cTnT Roche, hs-cTnI Siemens, hs-cTnI Beckman Coulter and hs-cTnI Abbott) in consecutive patients presenting to the emergency department with acute chest pain. Two independent cardiologists adjudicated the final diagnosis. Patients were followed for death or AMI during a mean period of 24 months. Results Among 2072 consecutive patients with hs-cTnT measurements available, 21.4% had an adjudicated diagnosis of AMI (sensitivity 89.6%, 95% CI 86.4% to 92.3%, negative predictive value (NPV): 96.5%, 95% CI 95.4% to 97.4%). Among 1180 consecutive patients with hs-cTnI Siemens measurements available, 20.0% had AMI (sensitivity 94.1%, 95% CI 90.3% to 96.7%, NPV: 98.0%, 95% CI: 96.6% to 98.9%). Among 1151 consecutive patients with hs-cTnI Beckman Coulter measurements available, 19.7% had AMI (sensitivity 92.1%, 95% CI 87.8% to 95.2%, NPV: 97.5%, 95% CI 96.0% to 98.5%). Among 1567 consecutive patients with hs-cTnI Abbott measurements available, 20.0% had AMI (sensitivity 77.2%, 95% CI 72.1% to 81.7%, NPV: 94.3%, 95% CI 92.8% to 95.5%). Conclusions Normal hs-cTn levels at presentation should not be used as a single parameter to rule out AMI as 6%-23% of adjudicated AMI cases had normal levels of hs-cTn levels at presentation. Our data highlight the lack of standardisation among hs-cTnI assays resulting in substantial differences in sensitivity and NPV at the 99th percentile.
UR - http://www.scopus.com/inward/record.url?scp=84885086897&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2013-303643
DO - 10.1136/heartjnl-2013-303643
M3 - SCORING: Journal article
C2 - 23604180
AN - SCOPUS:84885086897
VL - 99
SP - 1567
EP - 1572
JO - HEART
JF - HEART
SN - 1355-6037
IS - 21
ER -