Risk of myocardial infarction at specific troponin T levels using the parameter predictive value among lookalikes (PAL)
| Autor: | Max Petzold, Elvar Theodorsson, Ola Hammarsten, Christian Bjurman |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Clinical Biochemistry Myocardial Infarction 030204 cardiovascular system & hematology Chest pain Cohort Studies 03 medical and health sciences 0302 clinical medicine Troponin T Troponin complex Predictive Value of Tests Risk Factors Internal medicine medicine Humans Myocardial infarction business.industry General Medicine medicine.disease Surgery 030220 oncology & carcinogenesis Predictive value of tests Cohort Cardiology Biomarker (medicine) medicine.symptom business Cohort study |
| Zdroj: | Clinical Biochemistry. 50:6-10 |
| ISSN: | 0009-9120 |
| DOI: | 10.1016/j.clinbiochem.2016.09.012 |
| Popis: | Background Myocardial infarction is more likely if the heart damage biomarker cardiac troponin T (cTnT) is elevated in a blood sample, indicating that cardiac damage has occurred. No method allows the clinician to estimate the risk of myocardial infarction at a specific cTnT level in a given patient. Methods Predictive value among lookalikes (PAL) uses pre-test prevalence, sensitivity and specificity at adjacent cTnT limits based on percentiles. PAL is the pre-test prevalence-adjusted probability of disease between two adjacent cTnT limits. If a chest pain patient's cTnT level is between these limits, the risk of myocardial infarction can be estimated. Results The PAL based on percentiles had an acceptable sampling error when using 100 bootstrapped data of 18 different biomarkers from 38,945 authentic lab measurements. A PAL analysis of an emergency room cohort (n = 11,020) revealed that the diagnostic precision of a high-sensitive cTnT assay was similar among chest pain patients at different ages. The higher incidence of false positive results due to non-specific increases in cTnT in the high-age group was counterbalanced by a higher pre-test prevalence of myocardial infarction among older patients, a finding that was missed when using a conventional ROC plot analysis. Conclusions The PAL was able to calculate the risk of myocardial infarction at specific cTnT levels and could complement decision limits. |
| Databáze: | OpenAIRE |
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