High Sensitivity Cardiac Troponin in the Distinction of Acute Myocardial Infarction from Acute Cardiac Non-Coronary Artery Disease
Background—We hypothesized that high-sensitivity cardiac troponin (hs-cTn) and its early change are useful in distinguishing acute myocardial infarction (AMI) from acute cardiac non-coronary artery disease (CNCD).
Methods and Results—In a prospective, international multicenter study, hs-cTn was measured with three assays (hs-cTnT, Roche Diagnostics; hs-cTnI, Beckman-Coulter; hs-cTnI Siemens) in a blinded fashion at presentation and serially thereafter in 887 unselected patients with acute chest pain. Accuracy of the combination of presentation values with serial changes was compared against a final diagnosis adjudicated by two independent cardiologists. AMI was the adjudicated final diagnosis in 127 patients (15%), CNCD in 124 (14%). Patients with AMI had higher median presentation values of hs-cTnT (0.113 ug/l [0.049-0.246 ug/l] versus 0.012 ug/l [0.006-0.034 ug/l];p<0.001) and higher absolute changes of hs-cTnT in the first hour (0.019 ug/l [0.007-0.067 ug/l] versus 0.001 ug/l [0-0.003 ug/l];p<0.001) than patients with CNCD. Similar findings were obtained using the hs-cTnI assays. Adding changes of hs-cTn in the first hour to its presentation value yielded a diagnostic accuracy for AMI as quantified by the area under the receiver operating characteristics curve of 0.94 for hs-cTnT (0.92 for both hs-cTnI assays). Algorithms using ST-elevation, presentation values and changes of hs-cTn in the first hour accurately separated patients with AMI and CNCD. These findings were confirmed when the final diagnosis was re-adjudicated using hs-cTnT values and validated in an independent validation cohort.
Conclusions—The combined use of hs-cTn at presentation and its early absolute change excellently discriminate between patients with AMI and CNCD.
Clinical Trial Registration Information—clinicaltrials.gov; Identifier: NCT00470587.
- acute myocardial infarction
- coronary angiography
- cardiac, non-coronary artery disease
- decision curve analysis
- high-sensitivity cardiac troponin
- Received February 21, 2012.
- Accepted May 9, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited