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No additional value of conventional and high-sensitivity cardiac troponin over clinical scoring systems in the differential diagnosis of type 1 versus type 2 myocardial infarction.

Consuegra-Sánchez, L; Martínez-Díaz, JJ; de Guadiana-Romualdo, LG; Wasniewski, S; Esteban-Torrella, P; Clavel-Ruipérez, FG; Bardají, A; Castillo-Moreno, JA; Kaski, JC (2018) No additional value of conventional and high-sensitivity cardiac troponin over clinical scoring systems in the differential diagnosis of type 1 versus type 2 myocardial infarction. Clin Chem Lab Med, 56 (5). pp. 702-709. ISSN 1437-4331 https://doi.org/10.1515/cclm-2017-0609
SGUL Authors: Kaski, Juan Carlos

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Abstract

BACKGROUND: The distinction of type 1 and type 2 myocardial infarction (MI) is of major clinical importance. Our aim was to evaluate the diagnostic ability of absolute and relative conventional cardiac troponin I (cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) in the distinction between type 1 and type 2 MI in patients presenting at the emergency department with non-ST-segment elevation acute chest pain within the first 12 h. METHODS: We measured cTnI (Dimension Vista) and hs-cTnT (Cobas e601) concentrations at presentation and after 4 h in 200 patients presenting with suspected acute MI. The final diagnosis, based on standard criteria, was adjudicated by two independent cardiologists. RESULTS: One hundred and twenty-five patients (62.5%)were classified as type 1 MI and 75 (37.5%) were type 2 MI. In a multivariable setting, age (relative risk [RR]=1.43, p=0.040), male gender (RR=2.22, p=0.040), T-wave inversion (RR=8.51, p<0.001), ST-segment depression (RR=8.71, p<0.001) and absolute delta hs-cTnT (RR=2.10, p=0.022) were independently associated with type 1 MI. In a receiver operating characteristic curve analysis, the discriminatory power of absolute delta cTnI and hs-cTnT was significantly higher compared to relative c-TnI and hs-cTnT changes. The additive information provided by cTnI and hs-cTnT over and above the information provided by the "clinical" model was only marginal. CONCLUSIONS: The diagnostic information provided by serial measurements of conventional or hs-cTnT is not better than that yielded by a simple clinical scoring model. Absolute changes are more informative than relative troponin changes.

Item Type: Article
Additional Information: Published online in Clinical Chemistry and Laboratory Medicine at https://doi.org/10.1515/cclm-2017-0609
Keywords: cardiac troponin, clinical scores, differential diagnosis, myocardial infarction, General Clinical Medicine, 1103 Clinical Sciences, 1702 Cognitive Science
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Clin Chem Lab Med
ISSN: 1437-4331
Language: eng
Dates:
DateEvent
May 2018Published
5 January 2018Published Online
5 December 2017Accepted
Publisher License: Publisher's own licence
PubMed ID: 29303766
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/109554
Publisher's version: https://doi.org/10.1515/cclm-2017-0609

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