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Normal presenting levels of high-sensitivity troponin and myocardial infarction

2013; BMJ; Volume: 99; Issue: 21 Linguagem: Inglês

10.1136/heartjnl-2013-303643

1468-201X

Rebeca Hoeller, María Rubini Giménez, Tobias Reichlin, Raphael Twerenbold, Christa Zellweger, Berit Moehring, Karin Wildi, Michael Freese, Claudia Stelzig, Beate Hartmann, Melanie Stoll, Tamina Mosimann, Miriam Reiter, Philip Haaf, Mira Mueller, B. Meller, Thomas Hochgruber, Cathrin Balmelli, Seoung Mann Sou, Karsten Murray, Heike Freidank, Stephan Steuer, Jan Minners, Stefan Osswald, Christian Mueller,

Venous Thromboembolism Diagnosis and Management

Objective To analyse whether levels of high-sensitivity cardiac troponin (hs-cTn) below their respective 99th percentile can be used as a single parameter to rule out acute myocardial infarction (AMI) at presentation. Design Prospective, multicentre study. Main outcome measures We measured hs-cTn using four different methods (hs-cTnT Roche, hs-cTnI Siemens, hs-cTnI Beckman Coulter and hs-cTnI Abbott) in consecutive patients presenting to the emergency department with acute chest pain. Two independent cardiologists adjudicated the final diagnosis. Patients were followed for death or AMI during a mean period of 24 months. Results Among 2072 consecutive patients with hs-cTnT measurements available, 21.4% had an adjudicated diagnosis of AMI (sensitivity 89.6%, 95% CI 86.4% to 92.3%, negative predictive value (NPV): 96.5%, 95% CI 95.4% to 97.4%). Among 1180 consecutive patients with hs-cTnI Siemens measurements available, 20.0% had AMI (sensitivity 94.1%, 95% CI 90.3% to 96.7%, NPV: 98.0%, 95% CI: 96.6% to 98.9%). Among 1151 consecutive patients with hs-cTnI Beckman Coulter measurements available, 19.7% had AMI (sensitivity 92.1%, 95% CI 87.8% to 95.2%, NPV: 97.5%, 95% CI 96.0% to 98.5%). Among 1567 consecutive patients with hs-cTnI Abbott measurements available, 20.0% had AMI (sensitivity 77.2%, 95% CI 72.1% to 81.7%, NPV: 94.3%, 95% CI 92.8% to 95.5%). Conclusions Normal hs-cTn levels at presentation should not be used as a single parameter to rule out AMI as 6%–23% of adjudicated AMI cases had normal levels of hs-cTn levels at presentation. Our data highlight the lack of standardisation among hs-cTnI assays resulting in substantial differences in sensitivity and NPV at the 99th percentile.