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Incremental value of a single high-sensitivity cardiac Troponin I measurement to rule-out myocardial ischemia.
Am J Med. 2015 Jan 30;
Authors: Tanglay Y, Twerenbold R, Lee G, Wagener M, Honegger U, Puelacher C, Reichlin T, Sou SM, Druey S, Hochgruber T, Zürcher S, Radosavac M, Kreutzinger P, Pretre G, Stallone F, Hillinger P, Jaeger C, Gimenez MR, Freese M, Wild D, Rentsch K, Osswald S, Zellweger MJ, Mueller C
Abstract
BACKGROUND: The aim of this study was to investigate the value of a novel high-sensitivity cardiac troponin I (hs-cTnI) measurement to rule-out exercise-induced myocardial ischemia in patients without known coronary artery disease.
METHODS: We included 714 patients without previously known coronary artery disease referred for rest/stress myocardial perfusion single photon emission tomography (MPI-SPECT). All clinical information available to the treating cardiologist was used to quantify the clinical judgment regarding the presence of exercise-induced myocardial ischemia using a visual analogue scale twice: once prior and once after bicycle exercise stress-testing. Hs-cTnI measurements were obtained before stress-testing in a blinded manner. The presence of exercise-induced myocardial ischemia was adjudicated based on MPI-SPECT combined with coronary angiography findings.
RESULTS: Exercise-induced myocardial ischemia was detected in 167 (23.4%) participants. Hs-cTnI levels were significantly higher in patients with exercise-induced myocardial ischemia (4.0 ng/l [95%CI 2.8-8.6] vs. 2.6 ng/l [95%CI 1.8-4.1], p<0.001) and remained an independent predictor of ischemia in multivariable analysis (p<0.001). Combining clinical judgment prior to exercise testing with hs-cTnI levels increased diagnostic accuracy as quantified by the area under the receiver-operating curve from 0.64 to 0.73 (p<0.001), which tended to be superior also to clinical judgment after exercise testing (0.69, p=0.056). A single resting hs-cTnI measurement provided similar diagnostic accuracy as integrated clinical judgment after exercise testing including work load, as well as symptoms and ECG changes (0.70 vs. 0.69, p=ns).
CONCLUSION: hs-cTnI measurements seem to complement non-invasive clinical assessment in the patients with suspected coronary artery disease.
PMID: 25644323 [PubMed - as supplied by publisher]