TY - JOUR

T1 - Application of high-sensitivity troponin in suspected myocardial infarction

AU - Neumann, Johannes T.

AU - Twerenbold, Raphael

AU - Ojeda, Francisco

AU - Sörensen, Nils A.

AU - Chapman, Andrew R.

AU - Shah, Anoop S.V.

AU - Anand, Atul

AU - Boeddinghaus, Jasper

AU - Nestelberger, Thomas

AU - Badertscher, Patrick

AU - Mokhtari, Arash

AU - Pickering, John W.

AU - Troughton, Richard W.

AU - Greenslade, Jaimi

AU - Parsonage, William

AU - Mueller-Hennessen, Matthias

AU - Gori, Tommaso

AU - Jernberg, Tomas

AU - Morris, Niall

AU - Liebetrau, Christoph

AU - Hamm, Christian

AU - Katus, Hugo A.

AU - Münzel, Thomas

AU - Landmesser, Ulf

AU - Salomaa, Veikko

AU - Iacoviello, Licia

AU - Ferrario, Marco M.

AU - Giampaoli, Simona

AU - Kee, Frank

AU - Thorand, Barbara

AU - Peters, Annette

AU - Borchini, Rossana

AU - Jørgensen, Torben

AU - Söderberg, Stefan

AU - Sans, Susana

AU - Tunstall-Pedoe, Hugh

AU - Kuulasmaa, Kari

AU - Renné, Thomas

AU - Lackner, Karl J.

AU - Worster, Andrew

AU - Body, Richard

AU - Ekelund, Ulf

AU - Kavsak, Peter A.

AU - Keller, Till

AU - Lindahl, Bertil

AU - Wild, Philipp

AU - Giannitsis, Evangelos

AU - Than, Martin

AU - Cullen, Louise A.

AU - Mills, Nicholas L.

AU - Mueller, Christian

AU - Zeller, Tanja

AU - Westermann, Dirk

AU - Blankenberg, Stefan

PY - 2019

Y1 - 2019

N2 - BACKGROUND: Data regarding high-sensitivity troponin concentrations in patients presenting to the emergency department with symptoms suggestive of myocardial infarction may be useful in determining the probability of myocardial infarction and subsequent 30-day outcomes. METHODS: In 15 international cohorts of patients presenting to the emergency department with symptoms suggestive of myocardial infarction, we determined the concentrations of high-sensitivity troponin I or high-sensitivity troponin T at presentation and after early or late serial sampling. The diagnostic and prognostic performance of multiple high-sensitivity troponin cutoff combinations was assessed with the use of a derivation-validation design. A risk-assessment tool that was based on these data was developed to estimate the risk of index myocardial infarction and of subsequent myocardial infarction or death at 30 days. RESULTS: Among 22,651 patients (9604 in the derivation data set and 13,047 in the validation data set), the prevalence of myocardial infarction was 15.3%. Lower high-sensitivity troponin concentrations at presentation and smaller absolute changes during serial sampling were associated with a lower likelihood of myocardial infarction and a lower short-term risk of cardiovascular events. For example, high-sensitivity troponin I concentrations of less than 6 ng per liter and an absolute change of less than 4 ng per liter after 45 to 120 minutes (early serial sampling) resulted in a negative predictive value of 99.5% for myocardial infarction, with an associated 30-day risk of subsequent myocardial infarction or death of 0.2%; a total of 56.5% of the patients would be classified as being at low risk. These findings were confirmed in an external validation data set. CONCLUSIONS: A risk-assessment tool, which we developed to integrate the high-sensitivity troponin I or troponin T concentration at emergency department presentation, its dynamic change during serial sampling, and the time between the obtaining of samples, was used to estimate the probability of myocardial infarction on emergency department presentation and 30-day outcomes.

AB - BACKGROUND: Data regarding high-sensitivity troponin concentrations in patients presenting to the emergency department with symptoms suggestive of myocardial infarction may be useful in determining the probability of myocardial infarction and subsequent 30-day outcomes. METHODS: In 15 international cohorts of patients presenting to the emergency department with symptoms suggestive of myocardial infarction, we determined the concentrations of high-sensitivity troponin I or high-sensitivity troponin T at presentation and after early or late serial sampling. The diagnostic and prognostic performance of multiple high-sensitivity troponin cutoff combinations was assessed with the use of a derivation-validation design. A risk-assessment tool that was based on these data was developed to estimate the risk of index myocardial infarction and of subsequent myocardial infarction or death at 30 days. RESULTS: Among 22,651 patients (9604 in the derivation data set and 13,047 in the validation data set), the prevalence of myocardial infarction was 15.3%. Lower high-sensitivity troponin concentrations at presentation and smaller absolute changes during serial sampling were associated with a lower likelihood of myocardial infarction and a lower short-term risk of cardiovascular events. For example, high-sensitivity troponin I concentrations of less than 6 ng per liter and an absolute change of less than 4 ng per liter after 45 to 120 minutes (early serial sampling) resulted in a negative predictive value of 99.5% for myocardial infarction, with an associated 30-day risk of subsequent myocardial infarction or death of 0.2%; a total of 56.5% of the patients would be classified as being at low risk. These findings were confirmed in an external validation data set. CONCLUSIONS: A risk-assessment tool, which we developed to integrate the high-sensitivity troponin I or troponin T concentration at emergency department presentation, its dynamic change during serial sampling, and the time between the obtaining of samples, was used to estimate the probability of myocardial infarction on emergency department presentation and 30-day outcomes.

U2 - 10.1056/NEJMoa1803377

DO - 10.1056/NEJMoa1803377

M3 - Journal article

C2 - 31242362

AN - SCOPUS:85068262580

VL - 380

SP - 2529

EP - 2540

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 26

ER -