TY  - JOUR
A1  - Jeinsen, Beatrice von
A1  - Tzikas, Stergios
A1  - Pioro, Gerhard
A1  - Palapies, Lars
A1  - Zeller, Tanja
A1  - Bickel, Christoph
A1  - Lackner, Karl Johannes
A1  - Baldus, Stephan
A1  - Blankenberg, Stefan
A1  - Muenzel, Thomas
A1  - Zeiher, Andreas M.
A1  - Keller, Till
T1  - Troponin I assay for identification of a significant coronary stenosis in patients with suspected acute myocardial infarction and wide QRS complex
T2  - PLoS One
N2  - Background: Common ECG criteria such as ST-segment changes are of limited value in patients with suspected acute myocardial infarction (AMI) and bundle branch block or wide QRS complex. A large proportion of these patients do not suffer from an AMI, whereas those with ST-elevation myocardial infarction (STEMI) equivalent AMI benefit from an aggressive treatment. Aim of the present study was to evaluate the diagnostic information of cardiac troponin I (cTnI) in hemodynamically stable patients with wide QRS complex and suspected AMI.
Methods: In 417 out of 1818 patients presenting consecutively between 01/2007 and 12/2008 in a prospective multicenter observational study with suspected AMI a prolonged QRS duration was observed. Of these, n = 117 showed significant obstructive coronary artery disease (CAD) used as diagnostic outcome variable. cTnI was determined at admission.
Results: Patients with significant CAD had higher cTnI levels compared to individuals without (median 250ng/L vs. 11ng/L; p<0.01). To identify patients needing a coronary intervention, cTnI yielded an area under the receiver operator characteristics curve of 0.849. Optimized cut-offs with respect to a sensitivity driven rule-out and specificity driven rule-in strategy were established (40ng/L/96ng/L). Application of the specificity optimized cut-off value led to a positive predictive value of 71% compared to 59% if using the 99th percentile cut-off. The sensitivity optimized cut-off value was associated with a negative predictive value of 93% compared to 89% provided by application of the 99th percentile threshold.
Conclusion: cTnI determined in hemodynamically stable patients with suspected AMI and wide QRS complex using optimized diagnostic thresholds improves rule-in and rule-out with respect to presence of a significant obstructive CAD.
Y1  - 2016
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/41502
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-415027
SN  - 1932-6203
N1  - Copyright: © 2016 von Jeinsen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/ , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
VL  - 11
IS  - (5): e0154724
SP  - 1
EP  - 13
PB  - PLoS
CY  - Lawrence, Kan.
ER  -