Predicting Acute Myocardial Infarction with a Single Blood Draw.

Publisher DOI
PubMed ID
30626633
Abstract
BACKGROUND

We desired to determine cardiac troponin (cTn) concentrations necessary to achieve a positive predictive value (PPV) of ≥75% for acute myocardial infarction (AMI) to justify immediate admission of patients to a monitored unit and, in general, early coronary angiography.

METHODS

In a prospective multicenter diagnostic study enrolling patients presenting to the emergency department with symptoms suggestive of AMI, final diagnoses were adjudicated by 2 independent cardiologists based on clinical information including cardiac imaging. cTn concentrations were measured using 5 different sensitive and high-sensitivity cTn (hs-cTn) assays in a blinded fashion at presentation and serially thereafter. The diagnostic end point was PPV for rule-in of AMI of initial cTn concentrations alone and in combination with early changes.

RESULTS

Among 3828 patients, 616 (16%) had an AMI. At presentation, 7% to 14% of patients had cTnT/I concentrations associated with a PPV of ≥75%. Adding absolute or relative changes did not significantly further increase the PPV. PPVs increased from 46.5% (95% CI, 43.6-49.4) for hs-cTnT at presentation >14 ng/L to 78.9% (95% CI, 74.7-82.5) for >52 ng/L ( < 0.001), whereas PPVs in higher hs-cTnT strata remained largely unchanged [e.g., 82.4% (95% CI, 77.5-86.7) for >80 ng/L vs 83.9% (95% CI, 76.0-90.1) for >200 ng/L ( = 0.72)]. The addition of early changes in hs-cTnT further increased the PPV up to 60 ng/L, but not for higher concentrations.

CONCLUSIONS

Serial sampling does not seem necessary for predicting AMI and concurrent decision-making in about 10% of patients, as it only marginally increases the PPV for AMI and not in a statistically or clinically significant way.
Date Issued
2019-03
Publication Type
Article
Subject(s)
Language(s)
en
Author(s)
Boeddinghaus, Jasper
Nestelberger, Thomas
Badertscher, Patrick
Twerenbold, Raphael
Fitze, Brigitte
Wussler, Desiree
Strebel, Ivo
Giménez, Maria Rubini
Wildi, Karin
Puelacher, Christian
du Fay de Lavallaz, Jeanne
Oehen, Loris
Walter, Joan
Miró, Òscar
Martin-Sanchez, F Javier
Morawiec, Beata
Potlukova, Eliska
Keller, Dagmar I
Mueller, Christian
Additional Credits
Journal
Clinical chemistry
Publisher
American Association for Clinical Chemistry
ISSN
0009-9147
Access(Rights)
Unknown
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