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Boeddinghaus, Jasper; Nestelberger, Thomas; Badertscher, Patrick; Twerenbold, Raphael; Fitze, Brigitte; Wussler, Desiree; Strebel, Ivo; Rubini Giménez, Maria; Wildi, Karin; Puelacher, Christian; du Fay de Lavallaz, Jeanne; Oehen, Loris; Walter, Joan; Miró, Òscar; Martin-Sanchez, F Javier; Morawiec, Beata; Potlukova, Eliska; Keller, Dagmar I; Reichlin, Tobias; Mueller, Christian; Sabti, Zaid; Freese, Michael; Stelzig, Claudia; Shrestha, Samyut; [...]

Predicting Acute Myocardial Infarction with a Single Blood Draw

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  • Media type: E-Article
  • Title: Predicting Acute Myocardial Infarction with a Single Blood Draw
  • Contributor: Boeddinghaus, Jasper; Nestelberger, Thomas; Badertscher, Patrick; Twerenbold, Raphael; Fitze, Brigitte; Wussler, Desiree; Strebel, Ivo; Rubini Giménez, Maria; Wildi, Karin; Puelacher, Christian; du Fay de Lavallaz, Jeanne; Oehen, Loris; Walter, Joan; Miró, Òscar; Martin-Sanchez, F Javier; Morawiec, Beata; Potlukova, Eliska; Keller, Dagmar I; Reichlin, Tobias; Mueller, Christian; Sabti, Zaid; Freese, Michael; Stelzig, Claudia; Shrestha, Samyut; [...]
  • imprint: Oxford University Press (OUP), 2019
  • Published in: Clinical Chemistry
  • Language: English
  • DOI: 10.1373/clinchem.2018.294124
  • ISSN: 0009-9147; 1530-8561
  • Keywords: Biochemistry (medical) ; Clinical Biochemistry
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>BACKGROUND</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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 &amp;gt;14 ng/L to 78.9% (95% CI, 74.7–82.5) for &amp;gt;52 ng/L (P &amp;lt; 0.001), whereas PPVs in higher hs-cTnT strata remained largely unchanged [e.g., 82.4% (95% CI, 77.5–86.7) for &amp;gt;80 ng/L vs 83.9% (95% CI, 76.0–90.1) for &amp;gt;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.</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>ClinicalTrials.gov Identifier</jats:title> <jats:p>NCT00470587.</jats:p> </jats:sec>