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Sensitive troponin I assay in early diagnosis of acute myocardial infarction

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Sensitive troponin I assay in early diagnosis of acute myocardial infarction. / Keller, Till; Zeller, Tanja; Peetz, Dirk; Tzikas, Stergios; Roth, Alexander; Czyz, Ewa; Bickel, Christoph; Baldus, Stephan; Warnholtz, Ascan; Fröhlich, Meike; Sinning, Christoph R; Eleftheriadis, Medea S; Wild, Philipp S; Schnabel, Renate B; Lubos, Edith; Jachmann, Nicole; Genth-Zotz, Sabine; Post, Felix; Nicaud, Viviane; Tiret, Laurence; Lackner, Karl J; Münzel, Thomas F; Blankenberg, Stefan.

In: NEW ENGL J MED, Vol. 361, No. 9, 27.08.2009, p. 868-877.

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

Harvard

Keller, T, Zeller, T, Peetz, D, Tzikas, S, Roth, A, Czyz, E, Bickel, C, Baldus, S, Warnholtz, A, Fröhlich, M, Sinning, CR, Eleftheriadis, MS, Wild, PS, Schnabel, RB, Lubos, E, Jachmann, N, Genth-Zotz, S, Post, F, Nicaud, V, Tiret, L, Lackner, KJ, Münzel, TF & Blankenberg, S 2009, 'Sensitive troponin I assay in early diagnosis of acute myocardial infarction', NEW ENGL J MED, vol. 361, no. 9, pp. 868-877. https://doi.org/10.1056/NEJMoa0903515

APA

Keller, T., Zeller, T., Peetz, D., Tzikas, S., Roth, A., Czyz, E., Bickel, C., Baldus, S., Warnholtz, A., Fröhlich, M., Sinning, C. R., Eleftheriadis, M. S., Wild, P. S., Schnabel, R. B., Lubos, E., Jachmann, N., Genth-Zotz, S., Post, F., Nicaud, V., ... Blankenberg, S. (2009). Sensitive troponin I assay in early diagnosis of acute myocardial infarction. NEW ENGL J MED, 361(9), 868-877. https://doi.org/10.1056/NEJMoa0903515

Vancouver

Keller T, Zeller T, Peetz D, Tzikas S, Roth A, Czyz E et al. Sensitive troponin I assay in early diagnosis of acute myocardial infarction. NEW ENGL J MED. 2009 Aug 27;361(9):868-877. https://doi.org/10.1056/NEJMoa0903515

Bibtex

@article{c33b8ab27ef242c19792dc1225590378,
title = "Sensitive troponin I assay in early diagnosis of acute myocardial infarction",
abstract = "BACKGROUND: Cardiac troponin testing is central to the diagnosis of acute myocardial infarction. We evaluated a sensitive troponin I assay for the early diagnosis and risk stratification of myocardial infarction.METHODS: In a multicenter study, we determined levels of troponin I as assessed by a sensitive assay, troponin T, and traditional myocardial necrosis markers in 1818 consecutive patients with suspected acute myocardial infarction, on admission and 3 hours and 6 hours after admission.RESULTS: For samples obtained on admission, the diagnostic accuracy was highest with the sensitive troponin I assay (area under the receiver-operating-characteristic curve [AUC], 0.96), as compared with the troponin T assay (AUC, 0.85) and traditional myocardial necrosis markers. With the use of the sensitive troponin I assay (cutoff value, 0.04 ng per milliliter) on admission, the clinical sensitivity was 90.7%, and the specificity was 90.2%. The diagnostic accuracy was virtually identical in baseline and serial samples, regardless of the time of chest-pain onset. In patients presenting within 3 hours after chest-pain onset, a single sensitive troponin I assay had a negative predictive value of 84.1% and a positive predictive value of 86.7%; these findings predicted a 30% rise in the troponin I level within 6 hours. A troponin I level of more than 0.04 ng per milliliter was independently associated with an increased risk of an adverse outcome at 30 days (hazard ratio, 1.96; 95% confidence interval, 1.27 to 3.05; P=0.003).CONCLUSIONS: The use of a sensitive assay for troponin I improves early diagnosis of acute myocardial infarction and risk stratification, regardless of the time of chest-pain onset.",
keywords = "Aged, Angina, Unstable/blood, Area Under Curve, Biomarkers/blood, Chest Pain/etiology, Comorbidity, Early Diagnosis, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction/blood, Predictive Value of Tests, ROC Curve, Sensitivity and Specificity, Troponin I/blood, Troponin T/blood",
author = "Till Keller and Tanja Zeller and Dirk Peetz and Stergios Tzikas and Alexander Roth and Ewa Czyz and Christoph Bickel and Stephan Baldus and Ascan Warnholtz and Meike Fr{\"o}hlich and Sinning, {Christoph R} and Eleftheriadis, {Medea S} and Wild, {Philipp S} and Schnabel, {Renate B} and Edith Lubos and Nicole Jachmann and Sabine Genth-Zotz and Felix Post and Viviane Nicaud and Laurence Tiret and Lackner, {Karl J} and M{\"u}nzel, {Thomas F} and Stefan Blankenberg",
note = "2009 Massachusetts Medical Society",
year = "2009",
month = aug,
day = "27",
doi = "10.1056/NEJMoa0903515",
language = "English",
volume = "361",
pages = "868--877",
journal = "NEW ENGL J MED",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "9",

}

RIS

TY - JOUR

T1 - Sensitive troponin I assay in early diagnosis of acute myocardial infarction

AU - Keller, Till

AU - Zeller, Tanja

AU - Peetz, Dirk

AU - Tzikas, Stergios

AU - Roth, Alexander

AU - Czyz, Ewa

AU - Bickel, Christoph

AU - Baldus, Stephan

AU - Warnholtz, Ascan

AU - Fröhlich, Meike

AU - Sinning, Christoph R

AU - Eleftheriadis, Medea S

AU - Wild, Philipp S

AU - Schnabel, Renate B

AU - Lubos, Edith

AU - Jachmann, Nicole

AU - Genth-Zotz, Sabine

AU - Post, Felix

AU - Nicaud, Viviane

AU - Tiret, Laurence

AU - Lackner, Karl J

AU - Münzel, Thomas F

AU - Blankenberg, Stefan

N1 - 2009 Massachusetts Medical Society

PY - 2009/8/27

Y1 - 2009/8/27

N2 - BACKGROUND: Cardiac troponin testing is central to the diagnosis of acute myocardial infarction. We evaluated a sensitive troponin I assay for the early diagnosis and risk stratification of myocardial infarction.METHODS: In a multicenter study, we determined levels of troponin I as assessed by a sensitive assay, troponin T, and traditional myocardial necrosis markers in 1818 consecutive patients with suspected acute myocardial infarction, on admission and 3 hours and 6 hours after admission.RESULTS: For samples obtained on admission, the diagnostic accuracy was highest with the sensitive troponin I assay (area under the receiver-operating-characteristic curve [AUC], 0.96), as compared with the troponin T assay (AUC, 0.85) and traditional myocardial necrosis markers. With the use of the sensitive troponin I assay (cutoff value, 0.04 ng per milliliter) on admission, the clinical sensitivity was 90.7%, and the specificity was 90.2%. The diagnostic accuracy was virtually identical in baseline and serial samples, regardless of the time of chest-pain onset. In patients presenting within 3 hours after chest-pain onset, a single sensitive troponin I assay had a negative predictive value of 84.1% and a positive predictive value of 86.7%; these findings predicted a 30% rise in the troponin I level within 6 hours. A troponin I level of more than 0.04 ng per milliliter was independently associated with an increased risk of an adverse outcome at 30 days (hazard ratio, 1.96; 95% confidence interval, 1.27 to 3.05; P=0.003).CONCLUSIONS: The use of a sensitive assay for troponin I improves early diagnosis of acute myocardial infarction and risk stratification, regardless of the time of chest-pain onset.

AB - BACKGROUND: Cardiac troponin testing is central to the diagnosis of acute myocardial infarction. We evaluated a sensitive troponin I assay for the early diagnosis and risk stratification of myocardial infarction.METHODS: In a multicenter study, we determined levels of troponin I as assessed by a sensitive assay, troponin T, and traditional myocardial necrosis markers in 1818 consecutive patients with suspected acute myocardial infarction, on admission and 3 hours and 6 hours after admission.RESULTS: For samples obtained on admission, the diagnostic accuracy was highest with the sensitive troponin I assay (area under the receiver-operating-characteristic curve [AUC], 0.96), as compared with the troponin T assay (AUC, 0.85) and traditional myocardial necrosis markers. With the use of the sensitive troponin I assay (cutoff value, 0.04 ng per milliliter) on admission, the clinical sensitivity was 90.7%, and the specificity was 90.2%. The diagnostic accuracy was virtually identical in baseline and serial samples, regardless of the time of chest-pain onset. In patients presenting within 3 hours after chest-pain onset, a single sensitive troponin I assay had a negative predictive value of 84.1% and a positive predictive value of 86.7%; these findings predicted a 30% rise in the troponin I level within 6 hours. A troponin I level of more than 0.04 ng per milliliter was independently associated with an increased risk of an adverse outcome at 30 days (hazard ratio, 1.96; 95% confidence interval, 1.27 to 3.05; P=0.003).CONCLUSIONS: The use of a sensitive assay for troponin I improves early diagnosis of acute myocardial infarction and risk stratification, regardless of the time of chest-pain onset.

KW - Aged

KW - Angina, Unstable/blood

KW - Area Under Curve

KW - Biomarkers/blood

KW - Chest Pain/etiology

KW - Comorbidity

KW - Early Diagnosis

KW - Electrocardiography

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/blood

KW - Predictive Value of Tests

KW - ROC Curve

KW - Sensitivity and Specificity

KW - Troponin I/blood

KW - Troponin T/blood

U2 - 10.1056/NEJMoa0903515

DO - 10.1056/NEJMoa0903515

M3 - SCORING: Journal article

C2 - 19710485

VL - 361

SP - 868

EP - 877

JO - NEW ENGL J MED

JF - NEW ENGL J MED

SN - 0028-4793

IS - 9

ER -