Using High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic Patients: A Cohort Study.
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Using High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic Patients: A Cohort Study. / Walter, J; du, Fay de Lavallaz J; Koechlin, L; Zimmermann, T; Boeddinghaus, J; Honegger, U; Strebel, I; Twerenbold, R; Amrein, M; Nestelberger, T; Wussler, D; Mueller, C.
In: ANN INTERN MED, Vol. 172, No. 3, 01.2020, p. 175-185.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Using High-Sensitivity Cardiac Troponin for the Exclusion of Inducible Myocardial Ischemia in Symptomatic Patients: A Cohort Study.
AU - Walter, J
AU - du, Fay de Lavallaz J
AU - Koechlin, L
AU - Zimmermann, T
AU - Boeddinghaus, J
AU - Honegger, U
AU - Strebel, I
AU - Twerenbold, R
AU - Amrein, M
AU - Nestelberger, T
AU - Wussler, D
AU - Mueller, C
PY - 2020/1
Y1 - 2020/1
N2 - Background:The optimal noninvasive method for surveillance in symptomatic patients with stable coronary artery disease (CAD) is unknown.Objective:To apply a novel approach using very low concentrations of high-sensitivity cardiac troponin I (hs-cTnI) for exclusion of inducible myocardial ischemia in symptomatic patients with CAD.Design:Prospective diagnostic cohort study. (ClinicalTrials.gov: NCT01838148)Setting:University hospital.Patients:1896 consecutive patients with CAD referred with symptoms possibly related to inducible myocardial ischemia.Measurements:Presence of inducible myocardial ischemia was adjudicated using myocardial perfusion imaging with single-photon emission computed tomography, as well as coronary angiography and fractional flow reserve measurements where available. Staff blinded to adjudication measured circulating hs-cTn concentrations. An hs-cTnI cutoff of 2.5 ng/L, derived previously in mostly asymptomatic patients with CAD, was assessed. Predefined target performance criteria were at least 90% negative predictive value (NPV) and at least 90% sensitivity for exclusion of inducible myocardial ischemia. Sensitivity analyses were based on measurements with an hs-cTnT assay and an alternative hs-cTnI assay with even higher analytic sensitivity (limit of detection, 0.1 ng/L).Results:Overall, 865 patients (46%) had inducible myocardial ischemia. The hs-cTnI cutoff of 2.5 ng/L provided an NPV of 70% (95% CI, 64% to 75%) and a sensitivity of 90% (CI, 88% to 92%) for exclusion of inducible myocardial ischemia. No hs-cTnI cutoff reached both performance characteristics predefined as targets. Similarly, using the alternative assays for hs-cTnI or hs-cTnT, no cutoff achieved the target performance: hs-cTnT concentrations less than 5 ng/L yielded an NPV of 66% (CI, 59% to 72%), and hs-cTnI concentrations less than 2 ng/L yielded an NPV of 68% (CI, 62% to 74%).
AB - Background:The optimal noninvasive method for surveillance in symptomatic patients with stable coronary artery disease (CAD) is unknown.Objective:To apply a novel approach using very low concentrations of high-sensitivity cardiac troponin I (hs-cTnI) for exclusion of inducible myocardial ischemia in symptomatic patients with CAD.Design:Prospective diagnostic cohort study. (ClinicalTrials.gov: NCT01838148)Setting:University hospital.Patients:1896 consecutive patients with CAD referred with symptoms possibly related to inducible myocardial ischemia.Measurements:Presence of inducible myocardial ischemia was adjudicated using myocardial perfusion imaging with single-photon emission computed tomography, as well as coronary angiography and fractional flow reserve measurements where available. Staff blinded to adjudication measured circulating hs-cTn concentrations. An hs-cTnI cutoff of 2.5 ng/L, derived previously in mostly asymptomatic patients with CAD, was assessed. Predefined target performance criteria were at least 90% negative predictive value (NPV) and at least 90% sensitivity for exclusion of inducible myocardial ischemia. Sensitivity analyses were based on measurements with an hs-cTnT assay and an alternative hs-cTnI assay with even higher analytic sensitivity (limit of detection, 0.1 ng/L).Results:Overall, 865 patients (46%) had inducible myocardial ischemia. The hs-cTnI cutoff of 2.5 ng/L provided an NPV of 70% (95% CI, 64% to 75%) and a sensitivity of 90% (CI, 88% to 92%) for exclusion of inducible myocardial ischemia. No hs-cTnI cutoff reached both performance characteristics predefined as targets. Similarly, using the alternative assays for hs-cTnI or hs-cTnT, no cutoff achieved the target performance: hs-cTnT concentrations less than 5 ng/L yielded an NPV of 66% (CI, 59% to 72%), and hs-cTnI concentrations less than 2 ng/L yielded an NPV of 68% (CI, 62% to 74%).
U2 - 10.7326/m19-0080
DO - 10.7326/m19-0080
M3 - SCORING: Journal article
C2 - 31905377
VL - 172
SP - 175
EP - 185
JO - ANN INTERN MED
JF - ANN INTERN MED
SN - 0003-4819
IS - 3
ER -