Application of High-Sensitivity Troponin in Suspected Myocardial Infarction

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Application of High-Sensitivity Troponin in Suspected Myocardial Infarction

Neumann, J. T. (author): Karolinska Institutet

Twerenbold, R. (author): Univ Heart Ctr Hamburg, Hamburg, Germany;Univ Basel, Univ Hosp Basel, Cardiovasc Res Inst Basel, Basel, Switzerland;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland,Univ Med Ctr Hamburg Eppendorf, Inst Clin Chem & Lab Med, Hamburg, Germany

Ojeda, F. (author): Univ Heart Ctr Hamburg, Hamburg, Germany

Soerensen, N. A. (author): Univ Heart Ctr Hamburg, Hamburg, Germany;German Ctr Cardiovasc Res DZHK, Partner Site Hamburg Kiel Lubeck, Hamburg, Germany,Univ Edinburgh, British Heart Fdn, Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland

Chapman, A. R. (author): Univ Edinburgh, British Heart Fdn, Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland

Shah, A. S. V. (author): Univ Edinburgh, British Heart Fdn, Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland;Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Edinburgh, Midlothian, Scotland,Natl Inst Hlth & Welf, Helsinki, Finland,Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden;Umea Univ, Heart Ctr, Cardiol, Umea, Sweden,Catalan Dept Hlth, Barcelona, Spain

Anand, A. (author): Lund Univ, Skane Univ Hosp, Dept Internal & Emergency Med, Lund, Sweden,Heidelberg Univ Hosp, Dept Cardiol, Heidelberg, Germany;DZHK Partner Site Heidelberg Mannheim, Heidelberg, Germany,German Res Ctr Environm Hlth, Inst Epidemiol, Helmholtz Zentrum, Munich, Germany;DZHK Partner Site Munich Heart Alliance, Munich, Germany,McMaster Univ, Div Emergency Med, Hamilton, ON, Canada,McMaster Univ, Dept Pathol & Mol Med, Hamilton, ON, Canada,Royal Brisbane & Womens Hosp, Dept Emergency Med, Herston, Qld, Australia;Queensland Univ Technol, Inst Hlth & Biomed Innovat, Kelvin Grove, Australia

Boeddinghaus, J. (author): Univ Basel, Univ Hosp Basel, Cardiovasc Res Inst Basel, Basel, Switzerland;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland

Nestelberger, T. (author): Univ Basel, Univ Hosp Basel, Cardiovasc Res Inst Basel, Basel, Switzerland;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland

Badertscher, P. (author): Univ Basel, Univ Hosp Basel, Cardiovasc Res Inst Basel, Basel, Switzerland;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland

Mokhtari, Arash (author): Lund University,Lunds universitet,Thoraxkirurgi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,NPWT teknologin,Forskargrupper vid Lunds universitet,Skonsammare hjärtkirurgi,Thoracic Surgery,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,NPWT technology,Lund University Research Groups,Less invasive cardiac surgery

Pickering, J. W. (author): Univ Otago Christchurch, Dept Med, Christchurch, New Zealand;Christchurch Hosp, Emergency Dept, Christchurch, New Zealand,Johannes Gutenberg Univ Mainz, Ctr Cardiol, Prevent Cardiol & Prevent Med, Univ Med Ctr, Mainz, Germany;Johannes Gutenberg Univ Mainz, Univ Med Ctr, Ctr Thrombosis & Hemostasis, Mainz, Germany

Troughton, R. W. (author): Univ Otago Christchurch, Dept Med, Christchurch, New Zealand;Christchurch Hosp, Emergency Dept, Christchurch, New Zealand

Greenslade, J. (author): Royal Brisbane & Womens Hosp, Dept Emergency Med, Herston, Qld, Australia;Queensland Univ Technol, Inst Hlth & Biomed Innovat, Kelvin Grove, Australia

Parsonage, W. (author): Royal Brisbane & Womens Hosp, Cardiol, Herston, Qld, Australia;Queensland Univ Technol, Inst Hlth & Biomed Innovat, Kelvin Grove, Australia

Mueller-Hennessen, M. (author): Heidelberg Univ Hosp, Dept Cardiol, Heidelberg, Germany;DZHK Partner Site Heidelberg Mannheim, Heidelberg, Germany

Gori, T. (author): Johannes Gutenberg Univ Mainz, Cardiol 1, Univ Med Ctr, Mainz, Germany

Jernberg, T. (author)

Morris, N. (author): Univ Manchester, Manchester, Lancs, England;Manchester Univ Fdn Trust, Manchester, Lancs, England

Liebetrau, C. (author): Kerckhoff Heart & Thorax Ctr, DZHK Partner Site Rhine Main, Bad Nauheim, Germany;Kerckhoff Heart & Thorax Ctr, Dept Cardiol, Bad Nauheim, Germany;Justus Liebig Univ Giessen & Marburg, Dept Cardiol, Giessen, Germany

Hamm, C. (author): Kerckhoff Heart & Thorax Ctr, DZHK Partner Site Rhine Main, Bad Nauheim, Germany;Kerckhoff Heart & Thorax Ctr, Dept Cardiol, Bad Nauheim, Germany;Justus Liebig Univ Giessen & Marburg, Dept Cardiol, Giessen, Germany

Katus, H. A. (author)

Muenzel, T. (author): Johannes Gutenberg Univ Mainz, Cardiol 1, Univ Med Ctr, Mainz, Germany,Univ Otago Christchurch, Dept Med, Christchurch, New Zealand;Christchurch Hosp, Emergency Dept, Christchurch, New Zealand

Landmesser, U. (author): Charite Univ Med Berlin, Campus Benjamin Franklin, Berlin Inst Hlth, Dept Cardiol, Berlin, Germany;DZHK Partner Site Berlin, Berlin, Germany

Salomaa, V. (author)

Iacoviello, L. (author): Ist Ricovero & Cura Carattere Sci Neuromed, Dept Epidemiol & Prevent, Pozzilli, Italy;Univ Insubria, Res Ctr Epidemiol & Prevent Med, Dept Med & Surg, Varese, Italy

Ferrario, M. M. (author): Univ Insubria, Res Ctr Epidemiol & Prevent Med, Dept Med & Surg, Varese, Italy

Giampaoli, S. (author): Natl Inst Hlth, Dept Cardiovasc Dysmetabol & Aging Associated Dis, Rome, Italy

Kee, F. (author): Queens Univ Belfast, Clin Res Collaborat Publ Hlth, Belfast, Antrim, North Ireland

Thorand, B. (author): German Res Ctr Environm Hlth, Inst Epidemiol, Helmholtz Zentrum, Munich, Germany

Peters, A. (author)

Borchini, R. (author): Univ Insubria, Res Ctr Epidemiol & Prevent Med, Dept Med & Surg, Varese, Italy

Jorgensen, T. (author)

Söderberg, Stefan (author): Umeå universitet,Kardiologi,Univ Heart Ctr Hamburg, Hamburg, Germany;German Ctr Cardiovasc Res DZHK, Partner Site Hamburg Kiel Lubeck, Hamburg, Germany

Sans, S. (author)

Tunstall-Pedoe, H. (author): Univ Dundee, Inst Cardiovasc Res, Cardiovasc Epidemiol Unit, Dundee, Scotland

Kuulasmaa, K. (author): Natl Inst Hlth & Welf, Helsinki, Finland,Univ Med Ctr Mainz, Inst Clin Chem & Lab Med, Mainz, Germany

Renne, T. (author)

Lackner, K. J. (author)

Worster, A. (author)

Body, R. (author): Univ Manchester, Manchester, Lancs, England;Manchester Univ Fdn Trust, Manchester, Lancs, England

Ekelund, Ulf (author): Lund University,Lunds universitet,Medicin, Lund,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Experimentell kärlforskning,Forskargrupper vid Lunds universitet,Medicine, Lund,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Experimental Vascular Research,Lund University Research Groups

Kavsak, P. A. (author)

Keller, T. (author): Kerckhoff Heart & Thorax Ctr, DZHK Partner Site Rhine Main, Bad Nauheim, Germany;Kerckhoff Heart & Thorax Ctr, Dept Cardiol, Bad Nauheim, Germany,Univ Heart Ctr Hamburg, Hamburg, Germany;German Ctr Cardiovasc Res DZHK, Partner Site Hamburg Kiel Lubeck, Hamburg, Germany

Lindahl, Bertil, 1957- (author): Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)

Wild, P. (author)

Giannitsis, E. (author): Heidelberg Univ Hosp, Dept Cardiol, Heidelberg, Germany;DZHK Partner Site Heidelberg Mannheim, Heidelberg, Germany

Than, M. (author)

Cullen, L. A. (author)

Mills, N. L. (author): Univ Edinburgh, British Heart Fdn, Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland;Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Edinburgh, Midlothian, Scotland

Mueller, C. (author): Univ Basel, Univ Hosp Basel, Cardiovasc Res Inst Basel, Basel, Switzerland;Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland

Zeller, T. (author)

Westermann, D. (author): Univ Heart Ctr Hamburg, Hamburg, Germany;German Ctr Cardiovasc Res DZHK, Partner Site Hamburg Kiel Lubeck, Hamburg, Germany

Blankenberg, S. (author): German Centre for Cardiovascular Research,University Medical Center Hamburg-Eppendorf

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(creator_code:org_t)

et al

MASSACHUSETTS MEDICAL SOC, 2019
2019
English.
In: New England Journal of Medicine. - : MASSACHUSETTS MEDICAL SOC. - 0028-4793 .- 1533-4406. ; 380:26, s. 2529-2540

Related links:: http://dx.doi.org/10...; show more...; https://urn.kb.se/re...; https://doi.org/10.1...; https://urn.kb.se/re...; https://lup.lub.lu.s...; http://kipublication...; show less...

Journal article (peer-reviewed)

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BackgroundData regarding high-sensitivity troponin concentrations in patients presenting to the emergency department with symptoms suggestive of myocardial infarction may be useful in determining the probability of myocardial infarction and subsequent 30-day outcomes. MethodsIn 15 international cohorts of patients presenting to the emergency department with symptoms suggestive of myocardial infarction, we determined the concentrations of high-sensitivity troponin I or high-sensitivity troponin T at presentation and after early or late serial sampling. The diagnostic and prognostic performance of multiple high-sensitivity troponin cutoff combinations was assessed with the use of a derivation-validation design. A risk-assessment tool that was based on these data was developed to estimate the risk of index myocardial infarction and of subsequent myocardial infarction or death at 30 days. ResultsAmong 22,651 patients (9604 in the derivation data set and 13,047 in the validation data set), the prevalence of myocardial infarction was 15.3%. Lower high-sensitivity troponin concentrations at presentation and smaller absolute changes during serial sampling were associated with a lower likelihood of myocardial infarction and a lower short-term risk of cardiovascular events. For example, high-sensitivity troponin I concentrations of less than 6 ng per liter and an absolute change of less than 4 ng per liter after 45 to 120 minutes (early serial sampling) resulted in a negative predictive value of 99.5% for myocardial infarction, with an associated 30-day risk of subsequent myocardial infarction or death of 0.2%; a total of 56.5% of the patients would be classified as being at low risk. These findings were confirmed in an external validation data set. ConclusionsA risk-assessment tool, which we developed to integrate the high-sensitivity troponin I or troponin T concentration at emergency department presentation, its dynamic change during serial sampling, and the time between the obtaining of samples, was used to estimate the probability of myocardial infarction on emergency department presentation and 30-day outcomes.

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By the author/editor: Neumann, J. T.; Twerenbold, R.; Ojeda, F.; Soerensen, N. A.; Chapman, A. R.; Shah, A. S. V.; show more...; Anand, A.; Boeddinghaus, J.; Nestelberger, T.; Badertscher, P.; Mokhtari, Arash; Pickering, J. W.; Troughton, R. W.; Greenslade, J.; Parsonage, W.; Mueller-Hennesse ...; Gori, T.; Jernberg, T.; Morris, N.; Liebetrau, C.; Hamm, C.; Katus, H. A.; Muenzel, T.; Landmesser, U.; Salomaa, V.; Iacoviello, L.; Ferrario, M. M.; Giampaoli, S.; Kee, F.; Thorand, B.; Peters, A.; Borchini, R.; Jorgensen, T.; Söderberg, Stefa ...; Sans, S.; Tunstall-Pedoe, ...; Kuulasmaa, K.; Renne, T.; Lackner, K. J.; Worster, A.; Body, R.; Ekelund, Ulf; Kavsak, P. A.; Keller, T.; Lindahl, Bertil, ...; Wild, P.; Giannitsis, E.; Than, M.; Cullen, L. A.; Mills, N. L.; Mueller, C.; Zeller, T.; Westermann, D.; Blankenberg, S.; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

Articles in the publication: New England Jour ...

By the university: Umeå University; Uppsala University; Lund University; Karolinska Institutet

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Application of High-Sensitivity Troponin in Suspected Myocardial Infarction

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