Sensitive troponin assays in patients with suspected acute coronary syndrome: Results from the multicenter rule out myocardial infarction using computer assisted tomography II trial.

Abstract

BACKGROUND:

Sensitive troponin (Tn) assays have been developed for the evaluation of patients with suspected acute coronary syndrome (ACS). We sought to compare the performance of a commercially available sensitive Tn I (sTnI) and precommercial highly sTnI (hsTnI) method to conventional Tn (cTn) assays.

METHODS:

Among patients with acute chest pain but normal cTn in the emergency department of 6 centers, sTnI and hsTnI were measured at baseline, 2 and 4 hours after presentation. Diagnostic accuracy of sTnI and hsTnI relative to cTn for diagnosis during index hospitalization as well as their associations with coronary artery disease in patients randomized to coronary computed tomographic angiography (CTA) was assessed.

RESULTS:

Overall, 322 patients were enrolled, of whom 161 had a CTA; 28 had ACS (8.7%), including 21 with unstable angina pectoris (UAP). Both sTnI and hsTnI values at baseline and second draw had significantly higher sensitivity for ACS and UAP than cTn and had significantly greater area under the receiver operator characteristic curve than cTn at first and second draws. Compared with cTn, 29% of ACS cases previously categorized as UAP were reclassified to acute myocardial infarction with sTnI or hsTnI. An hsTnI below limit of detection had 100% negative predictive value for ACS or significant coronary artery stenosis in those randomized to CTA.

CONCLUSIONS:

In patients with acute chest discomfort, use of sTnI and hsTnI methods led to significant improvement in the early diagnostic accuracy for ACS, reclassifying one-third of UAP to myocardial infarction. Very low values for hsTnI excluded underlying coronary artery disease.

• Authors: James L Januzzi, Umesh Sharma, Pearl Zakroysky, Quynh A Truong, Pamela K Woodard, J Hector Pope, Thomas Hauser, Thomas Mayrhofer, J Toby Nagurney, David Schoenfeld, W Frank Peacock, Jerome L Fleg, Stephen Wiviott, Peter S Pang, James Udelson, Udo Hoffmann
• Journal: American heart journal (Am Heart J) Vol. 169 Issue 4 Pg. 572-8.e1 (Apr 2015) ISSN: 1097-6744 [Electronic] United States
• PMID: 25819865 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Troponin T

Topics

• Acute Coronary Syndrome (blood, diagnostic imaging)
• Biomarkers (blood)
• Early Diagnosis
• Electrocardiography
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Myocardial Infarction (blood, diagnostic imaging)
• Prospective Studies
• ROC Curve
• Reproducibility of Results
• Tomography, X-Ray Computed (methods)
• Troponin T (blood)