Identification of acute myocardial infarction in elderly patients using optimized highly sensitive troponin I thresholds.
Biomarkers. 2019 Jun 03;:1-23
Authors: von Jeinsen B, Liebetrau C, Palapies L, Tzikas S, Zeller T, Bickel C, Schmidt A, Tubaro M, Lackner KJ, Sar F, Baldus S, Zeiher AM, Blankenberg S, Gori T, Münzel T, Hamm CW, Wild PS, Keller T
Purpose: Established diagnostic thresholds for high-sensitivity cardiac troponins (hs-cTn) might not apply for elderly patients as they are elevated irrespective of the presence of an acute myocardial infarction (AMI). Aim of the present study was to investigate hs-cTnI in elderly patients with suspected AMI and to calculate optimized diagnostic cut-offs. Material and Methods: Data from a prospective multi-center study and from a second independent prospective single-center cohort study was analyzed. 2903 patients were eligible for further analysis. Patients >70 years were classified as elderly. hs-cTnI was measured upon admission. Results: 34.7% of 2903 patients were classified as elderly. 22.5% of elderly patients were finally diagnosed with AMI. Elderly patients had higher hs-cTnI levels at admission irrespective of the final diagnosis (p < 0.001). According to the AUROC, hs-cTnI was a strong marker for detection of AMI in elderly patients. Application of the 99th percentile cut-offs showed a substantially lower specificity in elderly. By using optimized thresholds, specificity was improved to levels as in younger patients in both cohorts but accompanied with a decrease in sensitivity. Conclusions: hs-cTnI levels have a lower specificity for detecting AMI in elderly patients. This lower specificity can be improved by using hs-cTnI thresholds optimized for elderly patients.
PMID: 31159594 [PubMed - as supplied by publisher]