High Sensitivity Cardiac Troponin in the Distinction of Acute Myocardial Infarction From Acute Cardiac Non-Coronary Artery Disease

Study Questions:

Can early change in high-sensitivity cardiac troponin (hs-cTn) distinguish acute myocardial infarction (AMI) from acute cardiac noncoronary artery disease (CNCD)?

Methods:

In a prospective, international, multicenter study, hs-cTn was measured with three assays (hs-cTnT, Roche Diagnostics; hs-cTnI, Beckman-Coulter; hs-cTnI Siemens) in 887 unselected patients with acute chest pain. Accuracy of the combination of presentation values with serial changes was compared against a final diagnosis adjudicated by two independent cardiologists.

Results:

AMI was the adjudicated final diagnosis in 127 patients (15%), whereas 124 (14%) were diagnosed to have CNCD. Patients with AMI had higher median presentation values of hs-cTnT (0.113 μg/L vs. 0.012 μg/L, p < 0.001) and higher absolute changes of hs-cTnT in the first hour (0.019 μg/L vs. 0.001 μ/L, p < 0.001) compared with patients with CNCD. Combining the presentation value and the change in the level of hs-cTn in the first hour yielded a diagnostic accuracy for AMI, as quantified by the area under the receiver operating characteristics curve of 0.94 for hs-cTnT (0.92 for both hs-cTnI assays). A simple algorithm using ST-elevation, presentation values, and change of hs-cTn in the first hour accurately separated patients with AMI and CNCD.

Conclusions:

The authors concluded that use of hs-cTn at presentation and its early absolute change accurately discriminate between patients with AMI and CNCD.

Perspective:

Acute chest pain is a common cause of emergency room visits. The authors demonstrate high diagnostic accuracy of using a baseline and 1-hour hs-cTn along with an electrocardiogram in early diagnosis of AMI. Such an approach, if validated, would allow a quicker rule out protocol, help triage patients faster, and ensure rapid treatment of patients with ACS while simultaneously reducing emergency room congestion and unnecessary observation of patients at low risk.

Clinical Topics: Atherosclerotic Disease (CAD/PAD)

Keywords: Heart Diseases, Coronary Artery Disease, Myocardial Infarction, Diterpenes, Biological Markers, Chest Pain, Cardiology, Cardiovascular Diseases, Electrocardiography, Troponin


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