Clinical investigationsImpact of the troponin standard on the prevalence of acute myocardial infarction
Section snippets
Methods
This study was performed at a 600-bed inner city hospital with approximately 85,000 ED visits a year. Approximately 2900 patients a year undergo an ED evaluation for ischemia, and of these, 1545 are admitted to the coronary care unit (CCU). The chest pain protocol used at our institution has been described in detail previously.9 After the initial evaluation, patients thought to be at high risk (those with ischemic echocardiographic [ECG] changes or with known coronary disease and typical
Results
Patient characteristics and demographic variables of the 2181 patients are shown in Table I. CK-MB MI was present in 170 patients (7.8%). The area under the ROC curve was 0.971 ± 0.005, indicating a high diagnostic test performance. The optimal diagnostic value, which increased specificity without significantly decreasing sensitivity, was 0.3 ng/mL. Using these diagnostic values, 152 patients (7.0%) had cTnI values between the LLD and the optimal diagnostic value; 115 patients (5.3%) had cTnI
Discussion
We found that varying the diagnostic threshold for cTnI resulted in clinically and statistically significant differences in the number of patients diagnosed with AMI. The number of additional patients diagnosed was highly dependent on the CK-MB standard used for comparison, as well as the ischemic risk of the patient population. Mortality was highest in patients who had CK-MB MI, intermediate in those who had cTnI MI but not CK-MB MI, and lowest in those without CK-MB MI or cTnI MI.
The
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