Abstract | BACKGROUND: Diagnosis of acute myocardial infarction (AMI) according to the universal definition is based on ischemic symptoms, imaging findings and elevated myocardial necrosis markers, preferably cardiac troponin I/T with diagnostic threshold representing the 99th percentile of a reference population. It is not clearly defined if this should be an unselected population-based or a healthy cohort with respect to cardiac diseases. Aim of the current study was to describe the distribution of troponin I using a sensitive assay and to evaluate the impact of cardiac diseases and cardiovascular risk factors in apparently healthy individuals. METHODS:
Troponin I was determined using a contemporary sensitive assay (TnI Ultra, Siemens) with 10% coefficient of variation (0.03 ng/mL) below the published 99th percentile (0.04 ng/mL) in 5000 participants (49.2% female) of the Gutenberg Health Study, a community-based, prospective, observational single-center cohort study. The calculated 99 th percentile cut-offs were tested in 1818 patients with suspected AMI. RESULTS:
Troponin I concentration representing the 99th percentile of the overall study population was 0.04 ng/mL. Excluding individuals with prevalent cardiovascular disease lowers the 99th percentile to 0.034 ng/mL. Exclusion of individuals with traditional risk factors or elevated natriuretic peptide leads to further reduction with 0.029/0.028 ng/mL. These lower cut-offs detect more patients at risk in individuals with suspected AMI. Correlations of troponin I with age, gender and traditional risk factors were observed. CONCLUSIONS:
Troponin I concentrations in apparently healthy individuals are dependent on prevalent cardiovascular diseases, traditional risk factors, gender and age. Application of corresponding cut-offs in diagnosis of AMI alters the group of patients potentially at risk.
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Authors | Till Keller, Francisco Ojeda, Tanja Zeller, Philipp S Wild, Stergios Tzikas, Christoph R Sinning, Dirk Peetz, Thomas Münzel, Stefan Blankenberg, Karl J Lackner |
Journal | International journal of cardiology
(Int J Cardiol)
Vol. 167
Issue 4
Pg. 1423-9
(Aug 20 2013)
ISSN: 1874-1754 [Electronic] Netherlands |
PMID | 22560907
(Publication Type: Journal Article, Observational Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2012 Elsevier Ireland Ltd. All rights reserved. |
Chemical References |
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Topics |
- Adult
- Age Factors
- Aged
- Biomarkers
(blood)
- Cardiovascular Diseases
(blood, diagnosis)
- Cohort Studies
- Cross-Sectional Studies
- Female
- Humans
- Male
- Middle Aged
- Population Surveillance
(methods)
- Prospective Studies
- Reference Values
- Risk Factors
- Sex Factors
- Troponin I
(blood)
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