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Predicting Acute Myocardial Infarction with a Single Blood Draw

Boeddinghaus, Jasper and Nestelberger, Thomas and Badertscher, Patrick and Twerenbold, Raphael and Fitze, Brigitte and Wussler, Desiree and Strebel, Ivo and Rubini Giménez, Maria and Wildi, Karin and Puelacher, Christian and du Fay de Lavallaz, Jeanne and Oehen, Loris and Walter, Joan and Miró, Òscar and Martin-Sanchez, F. Javier and Morawiec, Beata and Potlukova, Eliska and Keller, Dagmar I. and Reichlin, Tobias and Mueller, Christian and Apace Investigators, . (2019) Predicting Acute Myocardial Infarction with a Single Blood Draw. Clinical chemistry, 65 (3). pp. 437-450.

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Official URL: https://edoc.unibas.ch/76999/

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Abstract

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.; 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.; 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 >14 ng/L to 78.9% (95% CI, 74.7-82.5) for >52 ng/L (; P; 80 ng/L vs 83.9% (95% CI, 76.0-90.1) for >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.; 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.; NCT00470587.
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:Boeddinghaus, Jasper and Nestelberger, Thomas and Müller, Christian
Item Type:Article, refereed
Article Subtype:Research Article
ISSN:1530-8561
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:19 Aug 2020 13:17
Deposited On:19 Aug 2020 13:17

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