Differentiation between myopericarditis and acute myocardial infarction on presentation in the emergency department using the admission C-reactive protein to troponin ratio

Autor: Carmel Levin, Majdi Saada, Yaniv Levi, Aaron Frimerman, Rami Abu Fanne, Jameel Mohsen, Avraham Shotan, Michael Kleiner-Shochat, Randa Natour, Hamuda Nashed, Naama Amsalem, Ofer Kobo, Ariel Roguin, Simcha R. Meisel
Rok vydání: 2021
Předmět:
Male
Critical Care and Emergency Medicine
Myocardial Infarction
Cardiovascular Medicine
030204 cardiovascular system & hematology
Single Center
Biochemistry
Vascular Medicine
Diagnostic Radiology
030218 nuclear medicine & medical imaging
Medical Conditions
0302 clinical medicine
Medicine and Health Sciences
Coronary Heart Disease
Medicine
Myocardial infarction
Cardiovascular Imaging
Multidisciplinary
biology
Radiology and Imaging
Angiography
Middle Aged
C-Reactive Proteins
Troponin
Myocarditis
C-Reactive Protein
Cardiovascular Diseases
Cardiology
Female
Emergency Service
Hospital
Research Article
Adult
medicine.medical_specialty
Imaging Techniques
Science
Inflammatory Diseases
Context (language use)
Research and Analysis Methods
Diagnosis
Differential
03 medical and health sciences
Diagnostic Medicine
Internal medicine
Humans
cardiovascular diseases
Aged
business.industry
C-reactive protein
Biology and Life Sciences
Proteins
Emergency department
medicine.disease
Triage
Cytoskeletal Proteins
biology.protein
business
Myopericarditis
Zdroj: PLoS ONE
PLoS ONE, Vol 16, Iss 4, p e0248365 (2021)
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0248365
Popis: BackgroundThe treatment of myopericarditis is different than that of acute myocardial infarction (AMI). However, since their clinical presentation is frequently similar it may be difficult to distinguish between these entities despite a disparate underlying pathogenesis. Myopericarditis is primarily an inflammatory disease associated with high C-reactive protein (CRP) and relatively low elevated troponin concentrations, while AMI is characterized by the opposite. We hypothesized that evaluation of the CRP/troponin ratio on presentation to the emergency department could improve the differentiation between these two related clinical entities whose therapy is different. Such differentiation should facilitate triage to appropriate and expeditious therapy.MethodsWe evaluated the CRP/troponin ratio on presentation among patients consecutively included in a large single center registry that included 1898 consecutive patients comprising 1025 ST-elevation myocardial infarction (STEMI) patients, 518 Non-STEMI (NSTEMI) patients, and 355 patients diagnosed on discharge as myopericarditis. CRP and troponin were sampled on admission in all patients and their ratio was assessed against discharge diagnosis. ROC analysis of the CRP/troponin ratios evaluated the diagnostic accuracy of myopericarditis against all AMI, STEMI, and NSTEMI patients.ResultsMedian admission CRP/troponin ratios were 84, 65, and 436 mg×ml/liter×ng in STEMI, NSTEMI and myopericarditis groups, respectively (p500 resulted in specificity exceeding 85%, and for a ratio>1000, specificity>92%.ConclusionThe CRP/troponin ratio can serve as an effective tool to differentiate between myopericarditis and AMI. In the appropriate clinical context, the CRP/troponin ratio may preclude further evaluation.
Databáze: OpenAIRE
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