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Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay

  • 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.
Metadaten
Author:Christoph Liebetrau, Michael Weber, Stergios TzikasORCiDGND, Lars Palapies, Helge Möllmann, Gerhard Pioro, Tanja Zeller, Andrés Beiras FernándezGND, Christoph Bickel, Andreas M. ZeiherORCiDGND, Karl Johannes LacknerORCiD, Stephan BaldusGND, Holger M. Nef, Stefan Blankenberg, Christian Hamm, Thomas MünzelORCiDGND, Till KellerORCiDGND
URN:urn:nbn:de:hebis:30:3-380104
DOI:https://doi.org/10.1186/s12916-015-0410-8
ISSN:1741-7015
Pubmed Id:https://pubmed.ncbi.nlm.nih.gov/26212559
Parent Title (English):BMC medicine
Publisher:BioMed Central
Place of publication:London
Document Type:Article
Language:English
Date of Publication (online):2015/07/27
Date of first Publication:2015/07/27
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2015/09/06
Tag:Acute coronary syndrome; Atrial fibrillation; Cardiac troponin; Myocardial infarction
Volume:13
Issue:169
Page Number:9
First Page:1
Last Page:9
Note:
© 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.
HeBIS-PPN:370926951
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung 4.0

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