Journal
CIRCULATION
Volume 124, Issue 2, Pages 136-U66Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCULATIONAHA.111.023937
Keywords
acute myocardial infarction; chest pain diagnosis; high sensitive cardiac troponin assay; troponin
Funding
- Swiss National Science Foundation [PP00B-102853]
- Swiss Heart Foundation
- Abbott
- Roche
- Siemens
- Department of Internal Medicine
- University Hospital Basel
- Professor Max Cloetta Foundation
- University of Basel
- Biosite
- Brahms
- Nanosphere
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Background-Current guidelines for the diagnosis of acute myocardial infarction (AMI), among other criteria, also require a rise and/or fall in cardiac troponin (cTn) levels. It is unknown whether absolute or relative changes in cTn have higher diagnostic accuracy and should therefore be preferred. Methods and Results-In a prospective, observational, multicenter study, we analyzed the diagnostic accuracy of absolute (Delta) and relative (Delta%) changes in cTn in 836 patients presenting to the emergency department with symptoms suggestive of AMI. Blood samples for the determination of high-sensitive cTn T and cTn I ultra were collected at presentation and after 1 and 2 hours in a blinded fashion. The final diagnosis was adjudicated by 2 independent cardiologists. The area under the receiver operating characteristic curve for diagnosing AMI was significantly higher for 2-hour absolute (Delta) versus 2-hour relative (Delta%) cTn changes (area under the receiver operating characteristic curve [95% confidence interval], high-sensitivity cTn T: 0.95 [0.92 to 0.98] versus 0.76 [0.70 to 0.83], P < 0.001; cTn I ultra: 0.95 [0.91 to 0.99] versus 0.72 [0.66 to 0.79], P < 0.001). The receiver operating characteristic curve-derived cutoff value for 2-hour absolute (Delta) change was 0.007 mu g/L for high-sensitivity cTn T and 0.020 mu g/L for cTn I ultra (both cutoff levels are half of the 99th percentile of the respective cTn assay). Absolute changes were superior to relative changes in patients with both low and elevated baseline cTn levels. Conclusions-Absolute changes of cTn levels have a significantly higher diagnostic accuracy for AMI than relative changes, and seem therefore to be the preferred criteria to distinguish AMI from other causes of cTn elevations.
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