Abstract | AIMS: Assessment of patients with suspected non-ST elevation myocardial infarction ( NSTEMI) is based on cardiac troponin ( cTn) levels with the 99th percentile as cut-off. However, cardiovascular risk starts already at lower troponin concentrations. We therefore, aimed to investigate the utility of 2-hour algorithms using the high-sensitivity cardiac troponin I (hs-cTnI) 97.5th percentile as cut-off which corresponds to the standard URL for most biomarkers. METHODS: Hs-cTnI was measured at presentation and 2h in 1624 chest pain patients. Diagnostic algorithms were developed applying hs-cTnI levels dichotomized at the 99th and 97.5th percentiles combined with hs-cTnI changes and/or ECG findings. RESULTS: The prevalence of NSTEMI was 13.9%. The adjusted odds ratios for 1-year mortality were 2.7 (95% CI 1.4-5.1) for the 99th percentile and 3.1 (95% CI 1.6-5.9) for the 97.5th percentile. The best-performing 99th percentile-based algorithms provided a positive predictive value (PPV) of 86.3% and a negative predictive value (NPV) of 99.3%. Using 97.5th percentile-based algorithms to define NSTEMI resulted in few reclassifications and yielded similar diagnostic estimates (PPV 85.4%, NPV 99.4%). CONCLUSION: The hs-cTnI 97.5th percentile integrated into 2-hour algorithms provided high diagnostic estimates and could, due to better prognostic properties serve as an alternative to the 99th percentile.
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Authors | Kai M Eggers, Sally Aldous, Jaimi H Greenslade, Nina Johnston, Bertil Lindahl, William A Parsonage, John W Pickering, Martin Than, Louise Cullen |
Journal | Clinica chimica acta; international journal of clinical chemistry
(Clin Chim Acta)
Vol. 445
Pg. 19-24
(May 20 2015)
ISSN: 1873-3492 [Electronic] Netherlands |
PMID | 25771107
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2015 Elsevier B.V. All rights reserved. |
Chemical References |
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Topics |
- Acute Disease
- Aged
- Algorithms
- Biomarkers
(blood)
- Chest Pain
(blood, diagnosis, pathology)
- Early Diagnosis
- Female
- Humans
- Male
- Middle Aged
- Myocardial Infarction
(blood, diagnosis, pathology)
- Predictive Value of Tests
- Prognosis
- Survival Analysis
- Troponin I
(blood)
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