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Clin Chim Acta. 2011 Jan 14;412(1-2):91-7. doi: 10.1016/j.cca.2010.09.020. Epub 2010 Sep 22.

Clinical implications of the change of cardiac troponin I levels in patients with acute chest pain - an evaluation with respect to the Universal Definition of Myocardial Infarction.

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1
Department of Medical Sciences, Cardiology, Uppsala University Hospital, Sweden.

Abstract

BACKGROUND:

The Universal Definition of Myocardial Infarction incorporates elevated cardiac troponin levels (> 99th percentile) together with a significant rise/fall of troponins as biochemical criterion. We sought to evaluate the clinical implications of the relative change of cardiac troponin I (cTnI) levels with respect to the Universal Definition in patients with acute chest pain.

METHODS:

cTnI (Stratus CS) was measured serially in 454 patients within 24h from admission. Acute myocardial infarction (AMI) was defined using the criteria adapted to the ESC/ACC consensus document, or corresponding to the Universal Definition together with prespecified cTnI changes of ≥ 20%, ≥ 50% and ≥ 100%. Follow-up was completed after 5.8 years.

RESULTS:

A peak cTnI level above the 99th percentile together with a cTnI change of ≥ 20% was found in 160 patients of whom 25 did not have AMI according to the ESC/ACC criteria. These 160 patients had a significantly raised mortality (HR 2.5 [95% CI 1.7-3.8]). Higher cTnI deltas were not associated with higher mortalities but identified smaller patient cohorts at risk.

CONCLUSIONS:

The Universal Definition of AMI together with a ≥ 20% cTnI change appears to improve the discrimination of acute from chronic causes of cTnI release, and allows a reliable identification of patients at risk.

PMID:
20869357
DOI:
10.1016/j.cca.2010.09.020
[Indexed for MEDLINE]

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