Response to Letters Regarding Article, “High-Sensitivity Cardiac Troponin in the Distinction of Acute Myocardial Infarction From Acute Cardiac Noncoronary Artery Disease”
2013; Lippincott Williams & Wilkins; Volume: 127; Issue: 3 Linguagem: Inglês
10.1161/circulationaha.112.145201
ISSN1524-4539
AutoresPhilip Haaf, Beatrice Drexler, Tobias Reichlin, Raphael Twerenbold, Miriam Reiter, Julia Meißner, Nora Schaub, Claudia Stelzig, Michael Freese, Amely Heinzelmann, Christophe Meune, Cathrin Balmelli, Heike Freidank, Katrin Winkler, Kris Denhaerynck, Willibald Hochholzer, Stefan Osswald, Christian Mueller,
Tópico(s)Coronary Interventions and Diagnostics
ResumoHomeCirculationVol. 127, No. 3Response to Letters Regarding Article, "High-Sensitivity Cardiac Troponin in the Distinction of Acute Myocardial Infarction From Acute Cardiac Noncoronary Artery Disease" Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBResponse to Letters Regarding Article, "High-Sensitivity Cardiac Troponin in the Distinction of Acute Myocardial Infarction From Acute Cardiac Noncoronary Artery Disease" Philip Haaf, MD, Beatrice Drexler, MD, Tobias Reichlin, MD, Raphael Twerenbold, MD, Miriam Reiter, MD, Julia Meissner, MD, Nora Schaub, MD, Claudia Stelzig, MSc, Michael Freese, RN, Amely Heinzelmann, Christophe Meune, MD, PhD and Cathrin Balmelli, MD Heike Freidank, MD Katrin Winkler, MD Kris Denhaerynck, PhD and Willibald Hochholzer, MD Stefan Osswald, MD Christian Mueller, MD Philip HaafPhilip Haaf Department of Internal Medicine University Hospital Basel, Switzerland , Beatrice DrexlerBeatrice Drexler Department of Internal Medicine University Hospital Basel, Switzerland , Tobias ReichlinTobias Reichlin Department of Internal Medicine University Hospital Basel, Switzerland , Raphael TwerenboldRaphael Twerenbold Department of Internal Medicine University Hospital Basel, Switzerland , Miriam ReiterMiriam Reiter Department of Internal Medicine University Hospital Basel, Switzerland , Julia MeissnerJulia Meissner Department of Internal Medicine University Hospital Basel, Switzerland , Nora SchaubNora Schaub Department of Internal Medicine University Hospital Basel, Switzerland , Claudia StelzigClaudia Stelzig Department of Internal Medicine University Hospital Basel, Switzerland , Michael FreeseMichael Freese Department of Internal Medicine University Hospital Basel, Switzerland , Amely HeinzelmannAmely Heinzelmann Department of Internal Medicine University Hospital Basel, Switzerland , Christophe MeuneChristophe Meune Department of Internal Medicine University Hospital Basel, Switzerland and Cathrin BalmelliCathrin Balmelli Department of Internal Medicine University Hospital Basel, Switzerland Heike FreidankHeike Freidank Department of Laboratory Medicine University Hospital Basel, Switzerland Katrin WinklerKatrin Winkler Servicio de Pneumologia Hospital del Mar – IMIM, UPF, CIBERES, ISC III Barcelona, Spain Kris DenhaerynckKris Denhaerynck Department of Internal Medicine University Hospital Basel, Switzerland and Willibald HochholzerWillibald Hochholzer Department of Internal Medicine University Hospital Basel, Switzerland Stefan OsswaldStefan Osswald Department of Cardiology University Hospital Basel, Switzerland Christian MuellerChristian Mueller Department of Internal Medicine University Hospital Basel, Switzerland Originally published22 Jan 2013https://doi.org/10.1161/CIRCULATIONAHA.112.145201Circulation. 2013;127:e355–e356We thank Lippi et al1 for their interest in our work.2 They mention the fact that turnaround time may be >1 hour in many institutions. It is important to highlight that this observation does not interfere with our data or our conclusions. Our study refers to the time interval between the blood draw at presentation and the second blood draw. We fully agree with Lippi et al that, because of the turnaround time of ≈60 minutes, the results of the sample drawn at presentation will only become available for clinicians after 1 hour and the results of the 1-hour blood draw will only become available after 2 hours.We also fully agree with Lippi et al that it seems appropriate to continue to use the 3-hour time point recommended by the European Society of Cardiology guidelines until our findings are externally validated and confirmed.3We also wish to thank Carmo et al for their important comments. We fully agree that the availability of coronary angiography findings may have had an impact on the adjudication. However, it is critical to highlight that lesion severity is only 1 argument among many that were considered. Therefore, in the appropriate clinical setting, a patient may be adjudicated to have non–ST-segment elevation myocardial infarctioneven in the presence of completely normal coronary arteries. In contrast, again in the appropriate clinical setting, a patient may be considered to have acute musculoskeletal chest pain even in the presence of, for example, a 70% stenosis. We also agree that the Thrombolysis in Myocardial Infarction (TIMI) score or other risk prediction tools are helpful. We strongly disagree with their assumption that conventional troponin and TIMI score may have achieved the same discrimination at 1 hour. The Asia Pacific Evaluation of Chest Pain Trial (ASPECT) study nicely showed what can be achieved, but also what cannot be achieved with these tools.4 We fully agree with their third point that the differential diagnosis of patients with mildly elevated levels of high-sensitivity cardiac troponin at presentation and little change within the first hour is broad, and, therefore, their optimal management usually requires multiple additional diagnostic information.5Philip Haaf, MDBeatrice Drexler, MDTobias Reichlin, MDRaphael Twerenbold, MDMiriam Reiter, MDJulia Meissner, MDNora Schaub, MDClaudia Stelzig, MScMichael Freese, RNAmely HeinzelmannChristophe Meune, MD, PhDCathrin Balmelli, MDDepartment of Internal MedicineUniversity HospitalBasel, SwitzerlandHeike Freidank, MDDepartment of Laboratory MedicineUniversity HospitalBasel, SwitzerlandKatrin Winkler, MDServicio de PneumologiaHospital del Mar – IMIM, UPF, CIBERES, ISC IIIBarcelona, SpainKris Denhaerynck, PhDWillibald Hochholzer, MDDepartment of Internal MedicineUniversity HospitalBasel, SwitzerlandStefan Osswald, MDDepartment of CardiologyUniversity HospitalBasel, SwitzerlandChristian Mueller, MDDepartment of Internal MedicineUniversity HospitalBasel, SwitzerlandSources of FundingThe study was supported by research grants from the Swiss National Science Foundation (PP00B-102853), the Swiss Heart Foundation, Abbott, Beckam-Coulter, Roche, Nanosphere, Siemens, and the Department of Internal Medicine, University Hospital Basel.DisclosuresDr Mueller has received research support from the Swiss National Science Foundation (PP00B-102853), the Swiss Heart Foundation, the Stanley Thomas Johnson Foundation, Abbott, ALERE, Beckman-Coulter, Brahms, Nanosphere, Roche, Siemens, and the Department of Internal Medicine, University Hospital Basel, and speaker honoraria from Abbott, ALERE, Brahms, Roche, and Siemens. Dr Reichlin has received research grants from the University of Basel and the Department of Internal Medicine, University Hospital Basel, and speaker honoraria from Brahms, and Roche. Dr Meune was supported by a grant from the Freie Akademische Gesellschaft Basel (FAG). The other authors report no conflict.References1. Lippi G, Montagnana M, Aloe R, Cervellin G. Highly sensitive troponin immunoassays: navigating between the scylla and charybdis.Adv Clin Chem. 2012; 58:1–29.CrossrefMedlineGoogle Scholar2. Haaf P, Drexler B, Reichlin T, Twerenbold R, Reiter M, Meissner J, Schaub N, Stelzig C, Freese M, Heinzelmann A, Meune C, Balmelli C, Freidank H, Winkler K, Denhaerynck K, Hochholzer W, Osswald S, Mueller C. High-sensitivity cardiac troponin in the distinction of acute myocardial infarction from acute cardiac noncoronary artery disease.Circulation. 2012; 126:31–40.LinkGoogle Scholar3. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, Caso P, Dudek D, Gielen S, Huber K, Ohman M, Petrie MC, Sonntag F, Uva MS, Storey RF, Wijns W, Zahger D, Bax JJ, Auricchio A, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Knuuti J, Kolh P, McDonagh T, Moulin C, Poldermans D, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Torbicki A, Vahanian A, Windecker S, Windecker S, Achenbach S, Badimon L, Bertrand M, Bøtker HE, Collet JP, Crea F, Danchin N, Falk E, Goudevenos J, Gulba D, Hambrecht R, Herrmann J, Kastrati A, Kjeldsen K, Kristensen SD, Lancellotti P, Mehilli J, Merkely B, Montalescot G, Neumann FJ, Neyses L, Perk J, Roffi M, Romeo F, Ruda M, Swahn E, Valgimigli M, Vrints CJ, Widimsky P; ESC Committee for Practice Guidelines; Document Reviewers. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).Eur Heart J. 2011; 32:2999–3054.CrossrefMedlineGoogle Scholar4. Than M, Cullen L, Reid CM, Lim SH, Aldous S, Ardagh MW, Peacock WF, Parsonage WA, Ho HF, Ko HF, Kasliwal RR, Bansal M, Soerianata S, Hu D, Ding R, Hua Q, Seok-Min K, Sritara P, Sae-Lee R, Chiu TF, Tsai KC, Chu FY, Chen WK, Chang WH, Flaws DF, George PM, Richards AM. A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): a prospective observational validation study.Lancet. 2011; 377:1077–1084.CrossrefMedlineGoogle Scholar5. Twerenbold R, Jaffe A, Reichlin T, Reiter M, Mueller C. High-sensitive troponin T measurements: what do we gain and what are the challenges?Eur Heart J. 2012; 33:579–586.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Westwood M, van Asselt T, Ramaekers B, Whiting P, Thokala P, Joore M, Armstrong N, Ross J, Severens J and Kleijnen J (2015) High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people with acute chest pain: a systematic review and cost-effectiveness analysis, Health Technology Assessment, 10.3310/hta19440, 19:44, (1-234) January 22, 2013Vol 127, Issue 3 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.112.145201PMID: 23457724 Originally publishedJanuary 22, 2013 PDF download Advertisement SubjectsAcute Coronary SyndromesMyocardial Infarction
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