Optimal cut-off value for cardiac troponin I in ruling out Type 5 myocardial infarction

Autor: Tina Svenstrup Poulsen, Hans Mickley, Marianne Kjær Jensen, Mads Nybo, Poul Erik Mortensen, Peter Hartmund Jørgensen, Axel Cosmus Pyndt Diederichsen
Rok vydání: 2014
Předmět:
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Time Factors
Cardiac troponin
Coronary Artery Bypass/adverse effects
Myocardial Infarction
Coronary artery bypass grafting
Coronary Artery Disease
Postoperative complications
Coronary Artery Disease/blood
Electrocardiography
Coronary artery bypass surgery
Predictive Value of Tests
Risk Factors
Internal medicine
Cardiopulmonary Bypass/adverse effects
Troponin I
medicine
Humans
TYPE 5 MYOCARDIAL INFARCTION
Myocardial infarction
Coronary Artery Bypass
Aged
Cardiopulmonary Bypass
Receiver operating characteristic
business.industry
Cut off value
Middle Aged
medicine.disease
Troponin I/blood
Treatment Outcome
medicine.anatomical_structure
ROC Curve
Elective Surgical Procedures
Area Under Curve
Cardiology
Female
Surgery
Universal definition
Myocardial Infarction/blood
Cardiology and Cardiovascular Medicine
business
Biomarkers/blood
Biomarkers
Artery
Zdroj: Jørgensen, P H, Nybo, M, Jensen, M K, Mortensen, P E, Poulsen, T S, Diederichsen, A C P & Mickley, H 2014, ' Optimal cut-off value for cardiac troponin I in ruling out Type 5 myocardial infarction ', Interactive Cardiovascular and Thoracic Surgery, vol. 18, no. 5, pp. 544-550 . https://doi.org/10.1093/icvts/ivt558
ISSN: 1569-9285
1569-9293
DOI: 10.1093/icvts/ivt558
Popis: OBJECTIVES The clinical classification of myocardial infarction (MI) into five types was introduced in 2007 as a component of the universal definition. A Type 5 MI was defined as a MI related to coronary artery bypass surgery. In a setting of patients undergoing elective coronary artery bypass grafting, we set out (i) to describe the pattern of multiple serial cardiac troponin I (cTnI) measurements within 72 h postoperatively and (ii) to determine the optimal cardiac troponin I cut-off value in ruling in or ruling out a Type 5 MI. METHODS In 2011-2012, patients with two- and three-vessel disease scheduled for elective on-pump coronary artery bypass grafting were considered. Samples for cTnI were drawn before and 0, 2, 4, 6, 12, 24, 48 and 72 h after surgery. Analysis for cardiac troponin I was performed by use of the Abbott Architect c16000 system with an upper reference limit (URL) of 30 ng/l. The diagnosis of a Type 5 MI was prospectively made by a consultant cardiologist and was based on clinical, electrocardiographic and imaging data together with routine sampling and measurements of cTnI, but without knowledge of the results of serial study cTnI measurements. RESULTS Of the 141 eligible patients, 99 (70%) qualified for final enrolment. In 8 patients (8%), the clinical diagnosis of a Type 5 MI was made. Patients without Type 5 MI (n = 91) had a median cTnI peak value of 7675 ng/l compared with 20 500 ng/l in Type 5 MI patients (P = 0.01). By use of receiver operating characteristic curves, optimal cut-off values for identifying Type 5 MI were defined as 7970 ng/l (corresponding to 266 times the URL) 12 h postoperatively and 9950 ng/l (corresponding to 331 times the URL) 24 h postoperatively. These cut-off values resulted in negative predictive values of 0.99 (12 h) and 0.99 (24 h). Positive predictive values were 0.23 (12 h) and 0.35 (24 h). CONCLUSIONS In clinically stable patients undergoing elective coronary artery bypass grafting, measurements of cTnI are useful in ruling out a Type 5 MI.
Databáze: OpenAIRE
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