Predicting Acute Myocardial Infarction with a Single Blood Draw.

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; Reichlin, Tobias Roman and Mueller, Christian (2019). Predicting Acute Myocardial Infarction with a Single Blood Draw. Clinical chemistry, 65(3), pp. 437-450. American Association for Clinical Chemistry 10.1373/clinchem.2018.294124

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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.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
UniBE Contributor:	Reichlin, Tobias Roman
Subjects:	600 Technology > 610 Medicine & health
ISSN:	0009-9147
Publisher:	American Association for Clinical Chemistry
Language:	English
Submitter:	Tobias Roman Reichlin
Date Deposited:	23 Apr 2019 08:02
Last Modified:	05 Dec 2022 15:26
Publisher DOI:	10.1373/clinchem.2018.294124
PubMed ID:	30626633
URI:	https://boris.unibe.ch/id/eprint/126349