Format

Send to

Choose Destination
Clin Chem. 2019 Mar;65(3):437-450. doi: 10.1373/clinchem.2018.294124. Epub 2019 Jan 9.

Predicting Acute Myocardial Infarction with a Single Blood Draw.

Author information

1
Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
2
Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
3
GREAT Network, Rome, Italy.
4
Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.
5
Emergency Department, Hospital Clinic, Barcelona, Catalonia, Spain.
6
Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain.
7
2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Katowice, Katowice, Poland.
8
Emergency Department, University Hospital Zurich, Zurich, Switzerland.
9
Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; christian.mueller@usb.ch.

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 (P < 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 (P = 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.

CLINICALTRIALSGOV IDENTIFIER:

NCT00470587.

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center