Delta troponin for the early diagnosis of AMI in emergency patients with chest pain

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• 作者：Louise Cullen ; William A. Parsonage ; Jaimi Greenslade ; Arvin Lamanna ; Christopher J. Hammett ; Martin Than ; Jillian Tate ; Lauren Kalinowski ; Jacobus P.J. Ungerer ; Kevin Chu ; Anthony Brown
• 关键词：Chest pain ; Acute coronary syndrome ; Troponin ; Emergency medicine
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：3 October, 2013
• 年：2013
• 卷：168
• 期：3
• 页码：2602-2608
• 全文大小：568 K

文摘

Objectives

In patients presenting to the Emergency Department (ED) with potential acute myocardial infarction (AMI), elevated cardiac troponin (cTn) levels are indicative of myocardial necrosis. We assessed the accuracy of ¡®delta cTn¡¯ at 2 h or 6 h compared to the cTn concentration above the 99th percentile reference value for AMI in a prospective study of adult patients presenting to ED with symptoms suggestive of possible acute coronary syndrome.

Methods

Blood was sampled for cardiac troponin I (cTnI) on presentation, and at 2 h and 6 h following presentation using a sensitive assay (Beckman AccuTnI). All clinical endpoints were adjudicated by a cardiologist who was blinded to the 2 h cTn assay result.

Results

Of the 874 patients, 70 (8 % ) were diagnosed with an AMI during their index presentation. The area under the ROC curve for diagnosing AMI at 2 h was 0.89 [95 % CI, 0.84-0.95] for absolute delta cTn versus 0.79 [95 % CI 0.73-0.85] for the relative change. Specificity and PPV at 2 h were optimized using a delta cTnI ¡Ý 0.03 ¦Ìg/L (95.8 % [95 % CI 94.1-97.0] and 61.4 % [95 % CI 50.9-70.9] respectively). Sensitivity and NPV for AMI were optimized using the 99th percentile with the addition of a delta of < 0.03 ¦Ìg/L (97.1 % [95 % CI 90.2-99.2] and 99.7 % [95 % CI 99-99.9] respectively).

Conclusions

An algorithm incorporating cTnI concentration and delta cTn values with a sensitive troponin assay allows accurate diagnosis of AMI within 2 h from presentation and earlier rule-out of AMI in the majority of patients.