Publication details

Predicting Acute Myocardial Infarction with a Single Blood Draw

Authors	BOEDDINGHAUS Jasper NESTELBERGER Thomas BADERTSCHER Patrick TWERENBOLD Raphael FITZE Brigitte WUSSLER Desiree STREBEL Ivo GIMENEZ Maria Rubini WILDI Karin PUELACHER Christian DE LAVALLAZ Jeanne du Fay OEHEN Loris WALTER Joan MIRO Oscar MARTIN-SANCHEZ Javier F. MORAWIEC Beata POTLUKOVA Eliska KELLER Dagmar I. REICHLIN Tobias MUELLER Christian SABTI Zaid FREESE Michael STELZIG Claudia SHRESTHA Samyut SCHAERLI Nicolas KOZHUHAROV Nikola FLORES Dayana LOHRMANN Jens BISKUP Ewalina KLOOS Wanda OSSWALD Stefan MUELLER Deborah SAZGARY Lorraine LOPEZ Beatriz ADRADA Esther Rodriguez KAWECKI Damian MUZYK Piotr NOWALANY-KOZIELSKA Ewa PAŘENICA Jiří GANOVSKÁ Eva MEISSNER Kathrin KULANGARA Caroline MAHFOUZ Riham HARTMANN Beate FEREL Ina CAMPODARVE Isabel RENTSCH Katharina VON ECKARDSTEIN Arnold BUSER Andreas GEIGY Nicolas
Year of publication	2019
Type	Article in Periodical
Magazine / Source	Clinical Chemistry
MU Faculty or unit	Faculty of Medicine
Citation
web	http://dx.doi.org/10.1373/clinchem.2018.294124
Doi	http://dx.doi.org/10.1373/clinchem.2018.294124
Keywords	SENSITIVITY CARDIAC TROPONIN; CHEST-PAIN SYMPTOMS; HOUR RULE-IN; EARLY-DIAGNOSIS; 2-HOUR ALGORITHM; RELATIVE CHANGES; RAPID RULE; VALIDATION; ABSOLUTE; BIOMARKER
Description	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. (c) 2018 American Association for Clinical Chemistry