Diagnostic Performance of High Sensitivity Compared with Contemporary Cardiac Troponin I for the Diagnosis of Acute Myocardial Infarction
| Autor: | Sarah E. Thordsen, Benjamin K. Johnson, Johanna C. Moore, Jennifer Nicholson, Sara A. Love, Brian E. Driver, Fred S. Apple, Charles A. Bruen, Kenneth W. Dodd, Michelle D. Carlson, Katherine Jacoby, Stephen W. Smith, Anne Sexter, Yader Sandoval, Nathaniel L. Scott, Karen Schulz |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Percentile Cardiac troponin Clinical Biochemistry Myocardial Infarction 030204 cardiovascular system & hematology Sensitivity and Specificity 03 medical and health sciences 0302 clinical medicine Internal medicine Troponin I medicine Humans 030212 general & internal medicine Myocardial infarction Acute mi business.industry Clinical Laboratory Techniques Biochemistry (medical) Emergency department medicine.disease Prognosis Predictive value Surgery Cardiology Female Myocardial infarction diagnosis business Biomarkers |
| Zdroj: | Clinical chemistry. 63(10) |
| ISSN: | 1530-8561 0206-0760 |
| Popis: | BACKGROUND We examined the diagnostic performance of high-sensitivity cardiac troponin I (hs-cTnI) vs contemporary cTnI with use of the 99th percentile alone and with a normal electrocardiogram (ECG) to rule out acute myocardial infarction (MI) and serial changes (deltas) to rule in MI. METHODS We included consecutive patients presenting to a US emergency department with serial cTnI onclinical indication. Diagnostic performance for acute MI, including MI subtypes, and 30-day outcomes were examined. RESULTS Among 1631 patients, MI was diagnosed in 12.9% using the contemporary cTnI assay and in 10.4% using the hs-cTnI assay. For ruling out MI, contemporary cTnI ≤99th percentile at 0, 3, and 6 h and a normal ECG had a negative predictive value (NPV) of 99.5% (95% CI, 98.6–100) and a sensitivity of 99.1% (95% CI, 97.4–100) for diagnostic and safety outcomes. Serial hs-cTnI measurements ≤99th percentile at 0 and 3 h and a normal ECG had an NPV and sensitivity of 100% (95% CI, 100–100) for diagnostic and safety outcomes. For ruling in MI, contemporary cTnI measurements had specificities of 84.4% (95% CI, 82.5–86.3) at presentation and 78.7% (95% CI, 75.4–82.0) with serial testing at 0, 3, and 6 h, improving to 89.2% (95% CI, 87.1–91.3) by using serial cTnI changes (delta, 0 and 6 h) >150%. hs-cTnI had specificities of 86.9% (95% CI, 85.1–88.6) at presentation and 85.7% (95% CI, 83.5–87.9) with serial testing at 0 and 3 h, improving to 89.3% (95% CI, 87.3–91.2) using a delta hs-cTnI (0 and 3 h) >5 ng/L. CONCLUSIONS hs-cTnI and contemporary cTnI assays are excellent in ruling out MI following recommendations predicated on serial testing and the 99th percentile with a normal ECG. For ruling in MI, deltas improve the specificity. ClinicalTrials.gov Identifier: NCT02060760 |
| Databáze: | OpenAIRE |
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