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Early diagnosis of acute myocardial infarction in patients with mild elevations of cardiac troponin

J. Boeddinghaus, T. Reichlin, T. Nestelberger, R. Twerenbold, Y. Meili, K. Wildi, P. Hillinger, MR. Giménez, J. Cupa, L. Schumacher, M. Schubera, P. Badertscher, S. Corbière, K. Grimm, C. Puelacher, Z. Sabti, DF. Widmer, N. Schaerli, N....

. 2017 ; 106 (6) : 457-467. [pub] 20170201

Language English Country Germany

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc18010826
E-resources Online Full text

NLK ProQuest Central from 2005-01-01 to 2017-12-31
Medline Complete (EBSCOhost) from 2000-08-01 to 1 year ago
Health & Medicine (ProQuest) from 2005-01-01 to 2017-12-31

Links

PubMed 28150185
DOI 10.1007/s00392-016-1075-9
Knihovny.cz E-resources

BACKGROUND: The early diagnosis of acute myocardial infarction (AMI) in patients with mild elevations of high-sensitivity cardiac troponin (hs-cTn) is a challenge. It is unclear whether copeptin, a marker of endogenous stress, or 1h-hs-cTn changes are better suited to address this important unmet clinical need. METHODS: We prospectively enrolled patients presenting with symptoms suggestive of AMI to the emergency department (ED). Two independent cardiologists adjudicated the final diagnosis. Mild hs-cTn elevations were defined as 26.2 ng/L (99th percentile) to 75 ng/L for hs-cTnI, and 14 ng/L (99th percentile) to 50 ng/L (biological-equivalent to 75 ng/L for hs-cTnI) for hs-cTnT. RESULTS: Among 1356 patients, 80 (6%) had mild hs-cTnI elevations at presentation. Within this group, AMI was the final diagnosis in 39 patients (49%). The diagnostic accuracy for the diagnosis of AMI as quantified by the area under the receiver operating characteristic curve (AUC) was 0.51 (95% CI 0.39-0.64) for hs-cTnI at presentation, 0.58 (95% CI 0.45-0.71) for copeptin at presentation, and 0.78 (95% CI 0.68-0.88) for 1h-hs-cTnI changes, which was significantly higher as compared to copeptin (p = 0.02) or hs-cTnI alone (p < 0.001). The additional use of 1h-hs-cTnI changes, but not of copeptin, improved diagnostic accuracy of hs-cTnI at presentation (AUC 0.80, 95% CI 0.70-0.90; p = 0.002 for comparison). Similar findings regarding copeptin and 1h-hs-cTnT/I changes were obtained for mild hs-cTnT elevations. CONCLUSIONS: About 6-22% of patients presenting with suggestive AMI to the ED have mild hs-cTnT/I elevations at presentation. In contrast to copeptin, the addition of 1h-hs-cTn changes substantially improves the early diagnosis of AMI.

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$a Early diagnosis of acute myocardial infarction in patients with mild elevations of cardiac troponin / $c J. Boeddinghaus, T. Reichlin, T. Nestelberger, R. Twerenbold, Y. Meili, K. Wildi, P. Hillinger, MR. Giménez, J. Cupa, L. Schumacher, M. Schubera, P. Badertscher, S. Corbière, K. Grimm, C. Puelacher, Z. Sabti, DF. Widmer, N. Schaerli, N. Kozhuharov, S. Shrestha, T. Bürge, P. Mächler, M. Büchi, K. Rentsch, Ò. Miró, B. López, FJ. Martin-Sanchez, E. Rodriguez-Adrada, B. Morawiec, D. Kawecki, E. Ganovská, J. Parenica, J. Lohrmann, A. Buser, DI. Keller, S. Osswald, C. Mueller,
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$a BACKGROUND: The early diagnosis of acute myocardial infarction (AMI) in patients with mild elevations of high-sensitivity cardiac troponin (hs-cTn) is a challenge. It is unclear whether copeptin, a marker of endogenous stress, or 1h-hs-cTn changes are better suited to address this important unmet clinical need. METHODS: We prospectively enrolled patients presenting with symptoms suggestive of AMI to the emergency department (ED). Two independent cardiologists adjudicated the final diagnosis. Mild hs-cTn elevations were defined as 26.2 ng/L (99th percentile) to 75 ng/L for hs-cTnI, and 14 ng/L (99th percentile) to 50 ng/L (biological-equivalent to 75 ng/L for hs-cTnI) for hs-cTnT. RESULTS: Among 1356 patients, 80 (6%) had mild hs-cTnI elevations at presentation. Within this group, AMI was the final diagnosis in 39 patients (49%). The diagnostic accuracy for the diagnosis of AMI as quantified by the area under the receiver operating characteristic curve (AUC) was 0.51 (95% CI 0.39-0.64) for hs-cTnI at presentation, 0.58 (95% CI 0.45-0.71) for copeptin at presentation, and 0.78 (95% CI 0.68-0.88) for 1h-hs-cTnI changes, which was significantly higher as compared to copeptin (p = 0.02) or hs-cTnI alone (p < 0.001). The additional use of 1h-hs-cTnI changes, but not of copeptin, improved diagnostic accuracy of hs-cTnI at presentation (AUC 0.80, 95% CI 0.70-0.90; p = 0.002 for comparison). Similar findings regarding copeptin and 1h-hs-cTnT/I changes were obtained for mild hs-cTnT elevations. CONCLUSIONS: About 6-22% of patients presenting with suggestive AMI to the ED have mild hs-cTnT/I elevations at presentation. In contrast to copeptin, the addition of 1h-hs-cTn changes substantially improves the early diagnosis of AMI.
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$a Reichlin, Tobias $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Nestelberger, Thomas $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Twerenbold, Raphael $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Meili, Yvette $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Wildi, Karin $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Hillinger, Petra $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Giménez, Maria Rubini $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Cupa, Janosch $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Schumacher, Lukas $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Schubera, Marie $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Badertscher, Patrick $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Grimm, Karin $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Sabti, Zaid $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Schaerli, Nicolas $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Kozhuharov, Nikola $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Shrestha, Samyut $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. GREAT Network, Basel, Switzerland.
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$a Bürge, Tobias $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
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$a Büchi, Michael $u Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
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$a Buser, Andreas $u Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland. Department of Hematology, University Hospital Basel, Basel, Switzerland.
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