TY  - JOUR
A1  - Liebetrau, Christoph
A1  - Weber, Michael
A1  - Tzikas, Stergios
A1  - Palapies, Lars
A1  - Möllmann, Helge
A1  - Pioro, Gerhard
A1  - Zeller, Tanja
A1  - Beiras Fernández, Andrés
A1  - Bickel, Christoph
A1  - Zeiher, Andreas M.
A1  - Lackner, Karl Johannes
A1  - Baldus, Stephan
A1  - Nef, Holger M.
A1  - Blankenberg, Stefan
A1  - Hamm, Christian
A1  - Münzel, Thomas
A1  - Keller, Till
T1  - Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay
T2  - BMC medicine
N2  - Background: The introduction of modern troponin assays has facilitated diagnosis of acute myocardial infarction due to improved sensitivity with corresponding loss of specificity. Atrial fibrillation (AF) is associated with elevated levels of troponin. The aim of the present study was to evaluate the diagnostic performance of troponin I in patients with suspected acute coronary syndrome and chronic AF.
Methods: Contemporary sensitive troponin I was assayed in a derivation cohort of 90 patients with suspected acute coronary syndrome and chronic AF to establish diagnostic cut-offs. These thresholds were validated in an independent cohort of 314 patients with suspected myocardial infarction and AF upon presentation. Additionally, changes in troponin I concentration within 3 hours were used.
Results: In the derivation cohort, optimized thresholds with respect to a rule-out strategy with high sensitivity and a rule-in strategy with high specificity were established. In the validation cohort, application of the rule-out cut-off led to a negative predictive value of 97 %. The rule-in cut-off was associated with a positive predictive value of 88 % compared with 71 % if using the 99th percentile cut-off. In patients with troponin I levels above the specificity-optimized threshold, additional use of the 3-hour change in absolute/relative concentration resulted in a further improved positive predictive value of 96 %/100 %.
Conclusions: Troponin I concentration and the 3-hour change in its concentration provide valid diagnostic information in patients with suspected myocardial infarction and chronic AF. With regard to AF-associated elevation of troponin levels, application of diagnostic cut-offs other than the 99th percentile might be beneficial.
KW  - Acute coronary syndrome
KW  - Myocardial infarction
KW  - Atrial fibrillation
KW  - Cardiac troponin
Y1  - 2015
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/38010
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-380104
SN  - 1741-7015
N1  - © 2015 Liebetrau 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 work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
VL  - 13
IS  - 169
SP  - 1
EP  - 9
PB  - BioMed Central
CY  - London
ER  -