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

Boeddinghaus, Jasper
Author Boeddinghaus, Jasper 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
Reichlin, Tobias
Author Reichlin, Tobias Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland GREAT Network, Basel, Switzerland
Nestelberger, Thomas
Author Nestelberger, Thomas 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
Twerenbold, Raphael
Author Twerenbold, Raphael Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland GREAT Network, Basel, Switzerland
Meili, Yvette
Author Meili, Yvette Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland GREAT Network, Basel, Switzerland
Wildi, Karin
Author Wildi, Karin Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland GREAT Network, Basel, Switzerland
Hillinger, Petra
Author Hillinger, Petra 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
Giménez, Maria Rubini
Author Giménez, Maria Rubini 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
Cupa, Janosch
Author Cupa, Janosch Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland GREAT Network, Basel, Switzerland
Schumacher, Lukas
Author Schumacher, Lukas Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland GREAT Network, Basel, Switzerland
Schubera, Marie
Author Schubera, Marie Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland GREAT Network, Basel, Switzerland
Badertscher, Patrick
Author Badertscher, Patrick Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland GREAT Network, Basel, Switzerland
Corbière, Sydney
Author Corbière, Sydney Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland GREAT Network, Basel, Switzerland
Grimm, Karin
Author Grimm, Karin 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
Puelacher, Christian
Author Puelacher, Christian Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland GREAT Network, Basel, Switzerland
Sabti, Zaid
Author Sabti, Zaid Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland GREAT Network, Basel, Switzerland
Widmer, Dayana Flores
Author Widmer, Dayana Flores Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland GREAT Network, Basel, Switzerland
Schaerli, Nicolas
Author Schaerli, Nicolas 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
Kozhuharov, Nikola
Author Kozhuharov, Nikola Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland GREAT Network, Basel, Switzerland
Shrestha, Samyut
Author Shrestha, Samyut Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland GREAT Network, Basel, Switzerland
Bürge, Tobias
Author Bürge, Tobias Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
Mächler, Patrick
Author Mächler, Patrick Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
Büchi, Michael
Author Büchi, Michael Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
Rentsch, Katharina
Author Rentsch, Katharina Laboratory Medicine, University Hospital Basel, Basel, Switzerland
Miró, Òscar
Author Miró, Òscar GREAT Network, Basel, Switzerland Emergency Department, Hospital Clinic, Barcelona, Catalonia, Spain
López, Beatriz
Author López, Beatriz GREAT Network, Basel, Switzerland Emergency Department, Hospital Clinic, Barcelona, Catalonia, Spain
Martin-Sanchez, F Javier
Author Martin-Sanchez, F Javier Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain
Rodriguez-Adrada, Esther
Author Rodriguez-Adrada, Esther Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain
Morawiec, Beata
Author Morawiec, Beata 2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland
Kawecki, Damian
Author Kawecki, Damian 2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland
Ganovská, Eva
Author Ganovská, Eva GREAT Network, Basel, Switzerland Department of Cardiology, University Hospital Brno, Brno, Czech Republic Medical Faculty, Masaryk University, Brno, Czech Republic
Parenica, Jiri
Author Parenica, Jiri GREAT Network, Basel, Switzerland Department of Cardiology, University Hospital Brno, Brno, Czech Republic Medical Faculty, Masaryk University, Brno, Czech Republic
Lohrmann, Jens
Author Lohrmann, Jens Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
Buser, Andreas
Author Buser, Andreas Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland Department of Hematology, University Hospital Basel, Basel, Switzerland
Keller, Dagmar I
Author Keller, Dagmar I Emergency Department, University Hospital Zurich, Zurich, Switzerland
Osswald, Stefan
Author Osswald, Stefan Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
Mueller, Christian
Author Mueller, Christian Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. christian.mueller@usb.ch GREAT Network, Basel, Switzerland. christian.mueller@usb.ch

Clinical research in cardiology. 2017 Jun ; 106 (6) : 457-467. [epub] 20170201

Clin Res Cardiol
ISSN 1861-0692 | 1861-0684
Source

Language English Country Germany Media print-electronic

Document type Journal Article

Persistent link https://www.medvik.cz/link/pmid28150185

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

Keywords
Acute myocardial infarction, Copeptin, Diagnosis of AMI,
MeSH
Biomarkers blood MeSH
Early Diagnosis MeSH
Glycopeptides blood MeSH
Myocardial Infarction blood diagnosis MeSH
Middle Aged MeSH
Humans MeSH
Follow-Up Studies MeSH
Prospective Studies MeSH
ROC Curve MeSH
Aged, 80 and over MeSH
Aged MeSH
Troponin I blood MeSH
Troponin T blood MeSH
Emergency Service, Hospital MeSH
Check Tag
Middle Aged MeSH
Humans MeSH
Male MeSH
Aged, 80 and over MeSH
Aged MeSH
Female MeSH
Publication type
Journal Article MeSH
Names of Substances
Biomarkers MeSH
copeptins MeSH Browser
Glycopeptides MeSH
Troponin I MeSH
Troponin T MeSH

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.

2nd Department of Cardiology Medical University of Silesia Zabrze Poland

Blood Transfusion Centre Swiss Red Cross Basel Switzerland

Department of Cardiology Cardiovascular Research Institute Basel University Hospital Basel University of Basel Petersgraben 4 4031 Basel Switzerland

Department of Cardiology University Hospital Brno Brno Czech Republic

Department of Hematology University Hospital Basel Basel Switzerland

Department of Internal Medicine University Hospital Basel University of Basel Basel Switzerland

Emergency Department Hospital Clinic Barcelona Catalonia Spain

Emergency Department University Hospital Zurich Zurich Switzerland

GREAT Network Basel Switzerland

Laboratory Medicine University Hospital Basel Basel Switzerland

Medical Faculty Masaryk University Brno Czech Republic

Servicio de Urgencias Hospital Clínico San Carlos Madrid Spain