Universität zu Köln

von Jeinsen, Beatrice, Tzikas, Stergios ORCID: 0000-0002-7811-5620, Pioro, Gerhard, Palapies, Lars, Zeller, Tanja, Bickel, Christoph, Lackner, Karl J., Baldus, Stephan, Blankenberg, Stefan, Munzel, Thomas, Zeiher, Andreas M. and Keller, Till ORCID: 0000-0002-0895-6491 (2016). Troponin I Assay for Identification of a Significant Coronary Stenosis in Patients with Suspected Acute Myocardial Infarction and Wide QRS Complex. PLoS One, 11 (5). SAN FRANCISCO: PUBLIC LIBRARY SCIENCE. ISSN 1932-6203

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Abstract

Background Common ECG criteria such as ST-segment changes are of limited value in patients with suspected acute myocardial infarction (AMI) and bundle branch block or wide QRS complex. A large proportion of these patients do not suffer from an AMI, whereas those with ST-elevation myocardial infarction (STEMI) equivalent AMI benefit from an aggressive treatment. Aim of the present study was to evaluate the diagnostic information of cardiac troponin I (cTnI) in hemodynamically stable patients with wide QRS complex and suspected AMI. Methods In 417 out of 1818 patients presenting consecutively between 01/2007 and 12/2008 in a prospective multicenter observational study with suspected AMI a prolonged QRS duration was observed. Of these, n = 117 showed significant obstructive coronary artery disease (CAD) used as diagnostic outcome variable. cTnI was determined at admission. Results Patients with significant CAD had higher cTnI levels compared to individuals without (median 250ng/L vs. 11ng/L; p<0.01). To identify patients needing a coronary intervention, cTnI yielded an area under the receiver operator characteristics curve of 0.849. Optimized cut-offs with respect to a sensitivity driven rule-out and specificity driven rule-in strategy were established (40ng/L/96ng/L). Application of the specificity optimized cut-off value led to a positive predictive value of 71% compared to 59% if using the 99th percentile cut-off. The sensitivity optimized cut-off value was associated with a negative predictive value of 93% compared to 89% provided by application of the 99th percentile threshold. Conclusion cTnI determined in hemodynamically stable patients with suspected AMI and wide QRS complex using optimized diagnostic thresholds improves rule-in and rule-out with respect to presence of a significant obstructive CAD.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code von Jeinsen, Beatrice UNSPECIFIED UNSPECIFIED UNSPECIFIED Tzikas, Stergios UNSPECIFIED orcid.org/0000-0002-7811-5620 UNSPECIFIED Pioro, Gerhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Palapies, Lars UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeller, Tanja UNSPECIFIED UNSPECIFIED UNSPECIFIED Bickel, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Lackner, Karl J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Blankenberg, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Munzel, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeiher, Andreas M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Keller, Till UNSPECIFIED orcid.org/0000-0002-0895-6491 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-275879
DOI:	10.1371/journal.pone.0154724
Journal or Publication Title:	PLoS One
Volume:	11
Number:	5
Date:	2016
Publisher:	PUBLIC LIBRARY SCIENCE
Place of Publication:	SAN FRANCISCO
ISSN:	1932-6203
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language BUNDLE-BRANCH BLOCK; ST-SEGMENT ELEVATION; ELECTROCARDIOGRAPHIC DIAGNOSIS; ASSOCIATION; MANAGEMENT; PREVALENCE; GUIDELINES; CARDIOLOGY; CRITERIA; OUTCOMES Multiple languages Multidisciplinary Sciences Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/27587