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Early diagnosis of mi using serial troponin measurements
The recent introduction of high sensitivity troponin assays (hsT) has improved the sensitivity of this assay for the detection of myocardial infarction, while simultaneously decreasing specificity. To overcome this problem, the use of troponin kinetics—to identify acute myocardial damage—has been proposed, either alone or in combination with other diagnostic markers of cardiovascular disease.
One thousand eight hundred and eighteen patients with suspected acute coronary syndromes were recruited from three German hospitals between 2007 and 2008. Each patient had blood drawn for the detection of 12 biomarkers, including both normal (cTnI) and high sensitivity (hsTnI) troponin, on admission and at 3 and 6 h. The main outcome measure was the diagnostic performance of baseline and serial changes in hsTnI and cTnI results at 3 h after admission to the emergency department.
Of the 1818 patients, 413 (22.7%) were diagnosed as having had a myocardial infarction. The use of hsTnI at admission was found to have a sensitivity of 82.3% and a negative predictive value of 94.7%. By comparison, the use of cTnI at admission had a sensitivity of 79.4% and a negative predictive value of 94.0%. However, when levels were taken 3 h after admission, the sensitivity was 98.2% and the negative predictive value was 99.4% for both hsTnI and …