High Sensitivity Cardiac Troponin in the Distinction of Acute Myocardial Infarction from Acute Cardiac Non-Coronary Artery Disease.
Circulation. 2012 May 23;
Authors: Haaf P, Drexler B, Reichlin T, Twerenbold R, Reiter M, Meissner J, Schaub N, Stelzig C, Freese M, Heinzelmann A, Meune C, Balmelli C, Freidank H, Winkler K, Denhaerynck K, Hochholzer W, Osswald S, Mueller C
BACKGROUND: We hypothesized that high-sensitivity cardiac troponin (hs-cTn) and its early change are useful in distinguishing acute myocardial infarction (AMI) from acute cardiac non-coronary artery disease (CNCD). METHODS AND RESULTS: In a prospective, international multicenter study, hs-cTn was measured with three assays (hs-cTnT, Roche Diagnostics; hs-cTnI, Beckman-Coulter; hs-cTnI Siemens) in a blinded fashion at presentation and serially thereafter in 887 unselected patients with acute chest pain. Accuracy of the combination of presentation values with serial changes was compared against a final diagnosis adjudicated by two independent cardiologists. AMI was the adjudicated final diagnosis in 127 patients (15%), CNCD in 124 (14%). Patients with AMI had higher median presentation values of hs-cTnT (0.113 ug/l [0.049-0.246 ug/l] versus 0.012 ug/l [0.006-0.034 ug/l];p<0.001) and higher absolute changes of hs-cTnT in the first hour (0.019 ug/l [0.007-0.067 ug/l] versus 0.001 ug/l [0-0.003 ug/l];p<0.001) than patients with CNCD. Similar findings were obtained using the hs-cTnI assays. Adding changes of hs-cTn in the first hour to its presentation value yielded a diagnostic accuracy for AMI as quantified by the area under the receiver operating characteristics curve of 0.94 for hs-cTnT (0.92 for both hs-cTnI assays). Algorithms using ST-elevation, presentation values and changes of hs-cTn in the first hour accurately separated patients with AMI and CNCD. These findings were confirmed when the final diagnosis was re-adjudicated using hs-cTnT values and validated in an independent validation cohort. CONCLUSIONS: The combined use of hs-cTn at presentation and its early absolute change excellently discriminate between patients with AMI and CNCD. CLINICAL TRIAL REGISTRATION INFORMATION: clinicaltrials.gov; Identifier: NCT00470587.
PMID: 22623715 [PubMed - as supplied by publisher]