Troponin in early presenters to rule out myocardial infarction
European Heart Journal
Abstract
Whether a single cardiac troponin measurement can safely rule out myocardial infarction in patients presenting within a few hours of symptom onset is uncertain. The study aim was to assess the performance of troponin in early presenters.
In patients with possible myocardial infarction, the diagnostic performance of a single measurement of high-sensitivity cardiac troponin I at presentation was evaluated and externally validated in those tested ≤3, 4–12, and >12 h from symptom onset. The limit-of-detection (2 ng/L), rule-out (5 ng/L), and sex-specific 99th centile (16 ng/L in women; 34 ng/L in men) thresholds were compared. In 41 103 consecutive patients [60 (17) years, 46% women], 12 595 (31%) presented within 3 h, and 3728 (9%) had myocardial infarction. In those presenting ≤3 h, a threshold of 2 ng/L had greater sensitivity and negative predictive value [99.4% (95% confidence interval 99.2%–99.5%) and 99.7% (99.6%–99.8%)] compared with 5 ng/L [96.5% (96.2%–96.8%) and 99.3% (99.1%–99.4%)]. In those presenting ≥3 h, the sensitivity and negative predictive value were similar for both thresholds. The sensitivity of the 99th centile was low in early and late presenters at 71.4% (70.6%–72.2%) and 92.5% (92.0%–93.0%), respectively. Findings were consistent in an external validation cohort of 7088 patients.
In early presenters, a single measurement of high-sensitivity cardiac troponin I below the limit of detection may facilitate the safe rule out of myocardial infarction. The 99th centile should not be used to rule out myocardial infarction at presentation even in those presenting later following symptom onset.
Contributors
Matthew T H Lowry
Author
Dimitrios Doudesis
Author
Jasper Boeddinghaus
Author
Dorien M Kimenai
Author
Anda Bularga
Author
Caelan Taggart
Author
Ryan Wereski
Author
Amy V Ferry
Author
Stacey D Stewart
Author
Christopher Tuck
Author
Luca Koechlin
Author
Thomas Nestelberger
Author
Gabrielle Huré
Author
Kuan Ken Lee
Author
Andrew R Chapman
Author
Royal Infirmary of Edinburgh Edinburgh , United Kingdom of Great Britain & Northern Ireland
David E Newby
Author
Atul Anand
Author
Paul O Collinson
Author
Christian Mueller
Author
Nicholas L Mills
Author
University of Edinburgh Edinburgh , United Kingdom of Great Britain & Northern Ireland
Nicholas L Mills
Author
Fiona E Strachan
Author
Christopher Tuck
Author
Atul Anand
Author
Stephanie Barker
Author
Jennifer Blades
Author
Jasper Boeddinghaus
Author
Anda Bularga
Author
Andrew R Chapman
Author
Dimitrios Doudesis
Author
Amy V Ferry
Author
Takeshi Fujisawa
Author
Konstantin Georgiev
Author
Dorien M Kimenai
Author
Kuan Ken Lee
Author
Ziwen Li
Author
Matthew T H Lowry
Author
Lynn McKinlay
Author
Michael McDermott
Author
Jean McPherson
Author
Filip Mendusic
Author
Nicholas L Mills
Author
Andrew Sorbie
Author
Grace Souter
Author
Stacey D Schulberg
Author
Caelan Taggart
Author
Christopher Tuck
Author
Daniel Perez-Vicencio
Author
Yiqing Wang
Author
Ryan Wereski
Author
Kelly Williams
Author
Nicholas L Mills
Author
David E Newby
Author
Keith A A Fox
Author
Colin Berry
Author
Simon Walker
Author
Christopher J Weir
Author
Ian Ford
Author
Nicholas L Mills
Author
David E Newby
Author
Alasdair Gray
Author
Keith A A Fox
Author
Colin Berry
Author
Simon Walker
Author
Paul O Collinson
Author
Fred S Apple
Author
Alan Reid
Author
Anne Cruikshank
Author
Iain Findlay
Author
Shannon Amoils
Author
David A McAllister
Author
Donogh Maguire
Author
Jennifer Stevens
Author
John Norrie
Author
Christopher J Weir
Author
Anoop S V Shah
Author
Atul Anand
Author
Andrew R Chapman
Author
Kuan Ken Lee
Author
Jack P M Andrews
Author
Philip D Adamson
Author
Alastair Moss
Author
Mohamed S Anwar
Author
John Hung
Author
Nicholas L Mills
Author
Simon Walker
Author
Jonathan Malo
Author
Alan Reid
Author
Anne Cruikshank
Author
Paul O Collinson
Author
Colin M Fischbacher
Author
Bernard L Croal
Author
Stephen J Leslie
Author
Catriona Keerie
Author
Richard A Parker
Author
Allan Walker
Author
Ronnie Harkess
Author
Christopher Tuck
Author
Tony Wackett
Author
Christopher Weir
Author
Roma Armstrong
Author
Laura Stirling
Author
Claire MacDonald
Author
Imran Sadat
Author
Frank Finlay
Author
Kathy Harrison
Author
Atul Anand
Author
Pamela Linksted
Author
Stephen Lavenberg
Author
