Universität zu Köln

Liebetrau, Christoph, Weber, Michael, Tzikas, Stergios ORCID: 0000-0002-7811-5620, Palapies, Lars, Moellmann, Helge, Pioro, Gerhard, Zeller, Tanja ORCID: 0000-0003-3379-2641, Beiras-Fernandez, Andres, Bickel, Christoph, Zeiher, Andreas M., Lackner, Karl J., Baldus, Stephan, Nef, Holger M., Blankenberg, Stefan, Hamm, Christian W. ORCID: 0000-0001-6763-4161, Muenzel, Thomas ORCID: 0000-0001-5503-4150 and Keller, Till ORCID: 0000-0002-0895-6491 (2015). Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay. BMC Med., 13. LONDON: BMC. ISSN 1741-7015

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Abstract

Background: The introduction of modern troponin assays has facilitated diagnosis of acute myocardial infarction due to improved sensitivity with corresponding loss of specificity. Atrial fibrillation (AF) is associated with elevated levels of troponin. The aim of the present study was to evaluate the diagnostic performance of troponin I in patients with suspected acute coronary syndrome and chronic AF. Methods: Contemporary sensitive troponin I was assayed in a derivation cohort of 90 patients with suspected acute coronary syndrome and chronic AF to establish diagnostic cut-offs. These thresholds were validated in an independent cohort of 314 patients with suspected myocardial infarction and AF upon presentation. Additionally, changes in troponin I concentration within 3 hours were used. Results: In the derivation cohort, optimized thresholds with respect to a rule-out strategy with high sensitivity and a rule-in strategy with high specificity were established. In the validation cohort, application of the rule-out cut-off led to a negative predictive value of 97 %. The rule-in cut-off was associated with a positive predictive value of 88 % compared with 71 % if using the 99th percentile cut-off. In patients with troponin I levels above the specificity-optimized threshold, additional use of the 3-hour change in absolute/relative concentration resulted in a further improved positive predictive value of 96 %/100 %. Conclusions: Troponin I concentration and the 3-hour change in its concentration provide valid diagnostic information in patients with suspected myocardial infarction and chronic AF. With regard to AF-associated elevation of troponin levels, application of diagnostic cut-offs other than the 99th percentile might be beneficial.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Liebetrau, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Weber, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Tzikas, Stergios UNSPECIFIED orcid.org/0000-0002-7811-5620 UNSPECIFIED Palapies, Lars UNSPECIFIED UNSPECIFIED UNSPECIFIED Moellmann, Helge UNSPECIFIED UNSPECIFIED UNSPECIFIED Pioro, Gerhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeller, Tanja UNSPECIFIED orcid.org/0000-0003-3379-2641 UNSPECIFIED Beiras-Fernandez, Andres UNSPECIFIED UNSPECIFIED UNSPECIFIED Bickel, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeiher, Andreas M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lackner, Karl J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Nef, Holger M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Blankenberg, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Hamm, Christian W. UNSPECIFIED orcid.org/0000-0001-6763-4161 UNSPECIFIED Muenzel, Thomas UNSPECIFIED orcid.org/0000-0001-5503-4150 UNSPECIFIED Keller, Till UNSPECIFIED orcid.org/0000-0002-0895-6491 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-398649
DOI:	10.1186/s12916-015-0410-8
Journal or Publication Title:	BMC Med.
Volume:	13
Date:	2015
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1741-7015
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language EARLY-DIAGNOSIS; UNIVERSAL DEFINITION; RISK; ELEVATIONS; APIXABAN; EVENTS Multiple languages Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/39864