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Impact of the troponin standard on the prevalence of acute myocardial infarction.
Am Heart J. 2003 Sep; 146(3):446-52.AH

Abstract

BACKGROUND

Recent recommendations are that troponin should replace creatine kinase (CK)-MB as the diagnostic standard for myocardial infarction (MI). The impact of this change has not been well described. Our objective was to determine the impact of a troponin standard on the prevalence of acute non-ST-elevation MI.

METHODS

The current study was a retrospective analysis of consecutive patients without ST-segment elevation admitted for exclusion of myocardial ischemia to an inner city urban tertiary care center. All patients underwent serial marker sampling (CK, CK-MB, and cardiac troponin I [cTnI]). Patients with ST elevation consistent with acute MI (n = 130) or who did not have an 8 hour cTnI (n = 124) were excluded. The impact of 3 different cTnI diagnostic values were examined in 2181 patients: the lower limit of detectability (LLD); an optimal diagnostic value (OPT), chosen using receiver operator characteristic curve analysis; and the manufacturer's suggested upper reference level (URL), when compared to a gold standard CK-MB MI definition. In addition, MI prevalence was assessed using different CK-MB MI definitions and evaluated in patients with ischemic changes only.

RESULTS

The prevalence CK-MB MI was 7.8%. Using the various cTnI diagnostic values, the incidence of MI increased the prevalence by 28% to 195%. Using the optimal diagnostic value for cTnI, patients with cTnI elevations not meeting CK-MB MI criteria had an intermediate 30-day mortality (5.4%) compared to those with CK-MB MI (7.1%). Grouping the cTnI positive, CK-MB MI negative patients with the CK-MB MI patients rather than the non-CK-MB MI patients reduced mortality for both the MI (to 5.9%) and non-MI groups (from 1.9% to 1.6%).

CONCLUSIONS

Changing to a troponin standard will have a substantial impact on the number of patients diagnosed with MI. The revised definition for MI will have important clinical and health care implications.

Authors+Show Affiliations

Department of Internal Medicine, Cardiology Division, Medical College of Virginia, Virginia Commonwealth University, Richmond, Va 23298-0051, USA. mkontos@hsc.vcu.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12947361

Citation

Kontos, Michael C., et al. "Impact of the Troponin Standard On the Prevalence of Acute Myocardial Infarction." American Heart Journal, vol. 146, no. 3, 2003, pp. 446-52.
Kontos MC, Fritz LM, Anderson FP, et al. Impact of the troponin standard on the prevalence of acute myocardial infarction. Am Heart J. 2003;146(3):446-52.
Kontos, M. C., Fritz, L. M., Anderson, F. P., Tatum, J. L., Ornato, J. P., & Jesse, R. L. (2003). Impact of the troponin standard on the prevalence of acute myocardial infarction. American Heart Journal, 146(3), 446-52.
Kontos MC, et al. Impact of the Troponin Standard On the Prevalence of Acute Myocardial Infarction. Am Heart J. 2003;146(3):446-52. PubMed PMID: 12947361.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of the troponin standard on the prevalence of acute myocardial infarction. AU - Kontos,Michael C, AU - Fritz,Lucie M, AU - Anderson,F Philip, AU - Tatum,James L, AU - Ornato,Joseph P, AU - Jesse,Robert L, PY - 2003/8/30/pubmed PY - 2003/10/3/medline PY - 2003/8/30/entrez SP - 446 EP - 52 JF - American heart journal JO - Am Heart J VL - 146 IS - 3 N2 - BACKGROUND: Recent recommendations are that troponin should replace creatine kinase (CK)-MB as the diagnostic standard for myocardial infarction (MI). The impact of this change has not been well described. Our objective was to determine the impact of a troponin standard on the prevalence of acute non-ST-elevation MI. METHODS: The current study was a retrospective analysis of consecutive patients without ST-segment elevation admitted for exclusion of myocardial ischemia to an inner city urban tertiary care center. All patients underwent serial marker sampling (CK, CK-MB, and cardiac troponin I [cTnI]). Patients with ST elevation consistent with acute MI (n = 130) or who did not have an 8 hour cTnI (n = 124) were excluded. The impact of 3 different cTnI diagnostic values were examined in 2181 patients: the lower limit of detectability (LLD); an optimal diagnostic value (OPT), chosen using receiver operator characteristic curve analysis; and the manufacturer's suggested upper reference level (URL), when compared to a gold standard CK-MB MI definition. In addition, MI prevalence was assessed using different CK-MB MI definitions and evaluated in patients with ischemic changes only. RESULTS: The prevalence CK-MB MI was 7.8%. Using the various cTnI diagnostic values, the incidence of MI increased the prevalence by 28% to 195%. Using the optimal diagnostic value for cTnI, patients with cTnI elevations not meeting CK-MB MI criteria had an intermediate 30-day mortality (5.4%) compared to those with CK-MB MI (7.1%). Grouping the cTnI positive, CK-MB MI negative patients with the CK-MB MI patients rather than the non-CK-MB MI patients reduced mortality for both the MI (to 5.9%) and non-MI groups (from 1.9% to 1.6%). CONCLUSIONS: Changing to a troponin standard will have a substantial impact on the number of patients diagnosed with MI. The revised definition for MI will have important clinical and health care implications. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/12947361/Impact_of_the_troponin_standard_on_the_prevalence_of_acute_myocardial_infarction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S000287030300245X DB - PRIME DP - Unbound Medicine ER -