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Utility of Absolute and Relative Changes in Cardiac Troponin Concentrations in the Early Diagnosis of Acute Myocardial Infarction

Reichlin, Tobias and Irfan, Affan and Twerenbold, Raphael and Reiter, Miriam and Hochholzer, Willibald and Burkhalter, Hanna and Bassetti, Stefano and Steuer, Stephan and Winkler, Katrin and Peter, Federico and Meissner, Julia and Haaf, Philip and Potocki, Mihael and Drexler, Beatrice and Osswald, Stefan and Mueller, Christian. (2011) Utility of Absolute and Relative Changes in Cardiac Troponin Concentrations in the Early Diagnosis of Acute Myocardial Infarction. Circulation, Vol. 124, H. 2. pp. 136-145.

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Official URL: http://edoc.unibas.ch/dok/A5843829

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Abstract

Background- Current guidelines for the diagnosis of acute myocardial infarction (AMI), among other criteria, also require a rise and/or fall in cardiac troponin (cTn) levels. It is unknown whether absolute or relative changes in cTn have higher diagnostic accuracy and should therefore be preferred. Methods and Results- In a prospective, observational, multicenter study, we analyzed the diagnostic accuracy of absolute (?) and relative (?%) changes in cTn in 836 patients presenting to the emergency department with symptoms suggestive of AMI. Blood samples for the determination of high-sensitive cTn T and cTn I ultra were collected at presentation and after 1 and 2 hours in a blinded fashion. The final diagnosis was adjudicated by 2 independent cardiologists. The area under the receiver operating characteristic curve for diagnosing AMI was significantly higher for 2-hour absolute (?) versus 2-hour relative (?%) cTn changes (area under the receiver operating characteristic curve [95% confidence interval], high-sensitivity cTn T: 0.95 [0.92 to 0.98] versus 0.76 [0.70 to 0.83], P>0.001; cTn I ultra: 0.95 [0.91 to 0.99] versus 0.72 [0.66 to 0.79], P>0.001). The receiver operating characteristic curve-derived cutoff value for 2-hour absolute (?) change was 0.007 ?g/L for high-sensitivity cTn T and 0.020 ?g/L for cTn I ultra (both cutoff levels are half of the 99th percentile of the respective cTn assay). Absolute changes were superior to relative changes in patients with both low and elevated baseline cTn levels. Conclusions- Absolute changes of cTn levels have a significantly higher diagnostic accuracy for AMI than relative changes, and seem therefore to be the preferred criteria to distinguish AMI from other causes of cTn elevations. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00470587.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Infektiologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Infektiologie
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
UniBasel Contributors:Bassetti, Stefano and Müller, Christian and Reichlin, Tobias
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Lippincott Williams & Wilkins
ISSN:0009-7322
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:16 Aug 2013 07:32
Deposited On:08 Jun 2012 06:41

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