Combining High-Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute Myocardial Infarction

van der Linden, Noreen and Wildi, Karin and Twerenbold, Raphael and Pickering, John W. and Than, Martin and Cullen, Louise and Greenslade, Jaimi and Parsonage, William and Nestelberger, Thomas and Boeddinghaus, Jasper and Badertscher, Patrick and Rubini Giménez, Maria and Klinkenberg, Lieke J. J. and Bekers, Otto and Schöni, Aline and Keller, Dagmar I. and Sabti, Zaid and Puelacher, Christian and Cupa, Janosch and Schumacher, Lukas and Kozhuharov, Nikola and Grimm, Karin and Shrestha, Samyut and Flores, Dayana and Freese, Michael and Stelzig, Claudia and Strebel, Ivo and Miró, Òscar and Rentsch, Katharina and Morawiec, Beata and Kawecki, Damian and Kloos, Wanda and Lohrmann, Jens and Richards, A. Mark and Troughton, Richard and Pemberton, Christopher and Osswald, Stefan and van Dieijen-Visser, Marja P. and Mingels, Alma M. and Reichlin, Tobias and Meex, Steven J. R. and Mueller, Christian. (2018) Combining High-Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute Myocardial Infarction. Circulation, 138 (10). pp. 989-999.

[img] PDF - Accepted Version

Official URL: https://edoc.unibas.ch/71183/

Downloads: Statistics Overview


Combining 2 signals of cardiomyocyte injury, cardiac troponin I (cTnI) and T (cTnT), might overcome some individual pathophysiological and analytical limitations and thereby increase diagnostic accuracy for acute myocardial infarction with a single blood draw. We aimed to evaluate the diagnostic performance of combinations of high-sensitivity (hs) cTnI and hs-cTnT for the early diagnosis of acute myocardial infarction.; The diagnostic performance of combining hs-cTnI (Architect, Abbott) and hs-cTnT (Elecsys, Roche) concentrations (sum, product, ratio, and a combination algorithm) obtained at the time of presentation was evaluated in a large multicenter diagnostic study of patients with suspected acute myocardial infarction. The optimal rule-out and rule-in thresholds were externally validated in a second large multicenter diagnostic study. The proportion of patients eligible for early rule-out was compared with the European Society of Cardiology 0/1 and 0/3 hour algorithms.; Combining hs-cTnI and hs-cTnT concentrations did not consistently increase overall diagnostic accuracy as compared with the individual isoforms. However, the combination improved the proportion of patients meeting criteria for very early rule-out. With the European Society of Cardiology 2015 guideline recommended algorithms and cut-offs, the proportion meeting rule-out criteria after the baseline blood sampling was limited (6% to 24%) and assay dependent. Application of optimized cut-off values using the sum (9 ng/L) and product (18 ng; 2; /L; 2; ) of hs-cTnI and hs-cTnT concentrations led to an increase in the proportion ruled-out after a single blood draw to 34% to 41% in the original (sum: negative predictive value [NPV] 100% [95% confidence interval (CI), 99.5% to 100%]; product: NPV 100% [95% CI, 99.5% to 100%]) and in the validation cohort (sum: NPV 99.6% [95% CI, 99.0-99.9%]; product: NPV 99.4% [95% CI, 98.8-99.8%]). The use of a combination algorithm (hs-cTnI <4 ng/L and hs-cTnT <9 ng/L) showed comparable results for rule-out (40% to 43% ruled out; NPV original cohort 99.9% [95% CI, 99.2-100%]; NPV validation cohort 99.5% [95% CI, 98.9-99.8%]) and rule-in (positive predictive value [PPV] original cohort 74.4% [95% Cl, 69.6-78.8%]; PPV validation cohort 84.0% [95% Cl, 79.7-87.6%]).; New strategies combining hs-cTnI and hs-cTnT concentrations may significantly increase the number of patients eligible for very early and safe rule-out, but do not seem helpful for the rule-in of acute myocardial infarction.; URL (APACE): https://www.clinicaltrial.gov . Unique identifier: NCT00470587. URL (ADAPT): www.anzctr.org.au . Unique identifier: ACTRN12611001069943.
Faculties and Departments: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:Müller, Christian and Riesterer, Markus H.
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:American Heart Association
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
edoc DOI:
Last Modified:30 Jul 2019 15:33
Deposited On:30 Jul 2019 14:48

Repository Staff Only: item control page