Predicting Acute Myocardial Infarction with a Single Blood Draw

TY - JOUR

T1 - Predicting Acute Myocardial Infarction with a Single Blood Draw

AU - Boeddinghaus, Jasper

AU - Nestelberger, Thomas

AU - Badertscher, Patrick

AU - Twerenbold, Raphael

AU - Fitze, Brigitte

AU - Wussler, Desiree

AU - Strebel, Ivo

AU - Rubini Giménez, Maria

AU - Wildi, Karin

AU - Puelacher, Christian

AU - du Fay de Lavallaz, Jeanne

AU - Oehen, Loris

AU - Walter, Joan

AU - Miró, Òscar

AU - Martin-Sanchez, F Javier

AU - Morawiec, Beata

AU - Potlukova, Eliska

AU - Keller, Dagmar I

AU - Reichlin, Tobias

AU - Mueller, Christian

AU - APACE Investigators

N1 - © 2018 American Association for Clinical Chemistry.

PY - 2019/3

Y1 - 2019/3

N2 - BACKGROUND: We desired to determine cardiac troponin (cTn) concentrations necessary to achieve a positive predictive value (PPV) of ≥75% for acute myocardial infarction (AMI) to justify immediate admission of patients to a monitored unit and, in general, early coronary angiography.METHODS: In a prospective multicenter diagnostic study enrolling patients presenting to the emergency department with symptoms suggestive of AMI, final diagnoses were adjudicated by 2 independent cardiologists based on clinical information including cardiac imaging. cTn concentrations were measured using 5 different sensitive and high-sensitivity cTn (hs-cTn) assays in a blinded fashion at presentation and serially thereafter. The diagnostic end point was PPV for rule-in of AMI of initial cTn concentrations alone and in combination with early changes.RESULTS: Among 3828 patients, 616 (16%) had an AMI. At presentation, 7% to 14% of patients had cTnT/I concentrations associated with a PPV of ≥75%. Adding absolute or relative changes did not significantly further increase the PPV. PPVs increased from 46.5% (95% CI, 43.6-49.4) for hs-cTnT at presentation >14 ng/L to 78.9% (95% CI, 74.7-82.5) for >52 ng/L (P < 0.001), whereas PPVs in higher hs-cTnT strata remained largely unchanged [e.g., 82.4% (95% CI, 77.5-86.7) for >80 ng/L vs 83.9% (95% CI, 76.0-90.1) for >200 ng/L (P = 0.72)]. The addition of early changes in hs-cTnT further increased the PPV up to 60 ng/L, but not for higher concentrations.CONCLUSIONS: Serial sampling does not seem necessary for predicting AMI and concurrent decision-making in about 10% of patients, as it only marginally increases the PPV for AMI and not in a statistically or clinically significant way.CLINICALTRIALSGOV IDENTIFIER: NCT00470587.

AB - BACKGROUND: We desired to determine cardiac troponin (cTn) concentrations necessary to achieve a positive predictive value (PPV) of ≥75% for acute myocardial infarction (AMI) to justify immediate admission of patients to a monitored unit and, in general, early coronary angiography.METHODS: In a prospective multicenter diagnostic study enrolling patients presenting to the emergency department with symptoms suggestive of AMI, final diagnoses were adjudicated by 2 independent cardiologists based on clinical information including cardiac imaging. cTn concentrations were measured using 5 different sensitive and high-sensitivity cTn (hs-cTn) assays in a blinded fashion at presentation and serially thereafter. The diagnostic end point was PPV for rule-in of AMI of initial cTn concentrations alone and in combination with early changes.RESULTS: Among 3828 patients, 616 (16%) had an AMI. At presentation, 7% to 14% of patients had cTnT/I concentrations associated with a PPV of ≥75%. Adding absolute or relative changes did not significantly further increase the PPV. PPVs increased from 46.5% (95% CI, 43.6-49.4) for hs-cTnT at presentation >14 ng/L to 78.9% (95% CI, 74.7-82.5) for >52 ng/L (P < 0.001), whereas PPVs in higher hs-cTnT strata remained largely unchanged [e.g., 82.4% (95% CI, 77.5-86.7) for >80 ng/L vs 83.9% (95% CI, 76.0-90.1) for >200 ng/L (P = 0.72)]. The addition of early changes in hs-cTnT further increased the PPV up to 60 ng/L, but not for higher concentrations.CONCLUSIONS: Serial sampling does not seem necessary for predicting AMI and concurrent decision-making in about 10% of patients, as it only marginally increases the PPV for AMI and not in a statistically or clinically significant way.CLINICALTRIALSGOV IDENTIFIER: NCT00470587.

KW - Acute Disease

KW - Aged

KW - Aged, 80 and over

KW - Biomarkers/blood

KW - Blood Chemical Analysis/methods

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/diagnosis

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Troponin I/blood

KW - Troponin T/blood

U2 - 10.1373/clinchem.2018.294124

DO - 10.1373/clinchem.2018.294124

M3 - SCORING: Journal article

C2 - 30626633

VL - 65

SP - 437

EP - 450

JO - CLIN CHEM

JF - CLIN CHEM

SN - 0009-9147

IS - 3

ER -