Serial Change in hsTnI or cTnI Accurately Rule In/Out AMI

Change in highly sensitive or contemporary tropinin I at 3 hours after admission diagnostic

TUESDAY, Dec. 27 (HealthDay News) -- For patients admitted with suspected acute coronary syndrome (ACS), use of highly sensitive troponin I (hsTnI) or contemporary troponin I (cTnI) assays on admission, and changes in their levels within three hours, can confirm the diagnosis of acute myocardial infarction (AMI), according to a study published in the Dec. 28 issue of the Journal of the American Medical Association.

Till Keller, M.D., from the University Heart Center Hamburg in Germany, and colleagues compared the diagnostic performance of hsTnI assay with cTnI assay at baseline, and their serial changes within three hours, in the diagnosis of AMI in 1,818 patients with suspected ACS. On admission, and at three and six hours after admission, participants underwent measurements for 12 biomarkers, including hsTnI and cTnI.

The investigators found that 22.7 percent of the patients were diagnosed with AMI. On admission, the area under the receiver operating characteristic curve for acute MI discrimination was 0.96 for hsTnI and 0.92 for cTnI, both of which were superior to the other diagnostic markers. On admission, using the 99th percentile as a cutoff, the sensitivity and negative predictive value (NPV) were 82.3 and 94.7 percent, respectively, for hsTn1; and 79.4 and 94.0 percent, respectively, for cTn1. Using levels at three hours after admission, the sensitivity and NPV for both hsTnI and cTnI were 98.2 and 99.4 percent, respectively. When the 99th percentile cut-off on admission was combined with serial troponin changes within three hours, the positive predictive value of hsTnI increased from 75.1 to 95.8 percent, and the positive predictive value of cTnI increased from 80.9 to 96.1 percent.

"Use of hsTnI and cTnI assays in patients with suspected MI provides useful diagnostic information," the authors write.

Several authors disclosed financial relationships with pharmaceutical and biotechnology companies, including Brahms AG and Abbott Diagnostics, which partially funded the study.

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