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Troponin I Assay for Identification of a Significant Coronary Stenosis in Patients with Suspected Acute Myocardial Infarction and Wide QRS Complex
BACKGROUND: Common ECG criteria such as ST-segment changes are of limited value in patients with suspected acute myocardial infarction (AMI) and bundle branch block or wide QRS complex. A large proportion of these patients do not suffer from an AMI, whereas those with ST-elevation myocardial infarct...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4858235/ https://www.ncbi.nlm.nih.gov/pubmed/27148734 http://dx.doi.org/10.1371/journal.pone.0154724 |
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author | von Jeinsen, Beatrice Tzikas, Stergios Pioro, Gerhard Palapies, Lars Zeller, Tanja Bickel, Christoph Lackner, Karl J. Baldus, Stephan Blankenberg, Stefan Muenzel, Thomas Zeiher, Andreas M. Keller, Till |
author_facet | von Jeinsen, Beatrice Tzikas, Stergios Pioro, Gerhard Palapies, Lars Zeller, Tanja Bickel, Christoph Lackner, Karl J. Baldus, Stephan Blankenberg, Stefan Muenzel, Thomas Zeiher, Andreas M. Keller, Till |
author_sort | von Jeinsen, Beatrice |
collection | PubMed |
description | BACKGROUND: Common ECG criteria such as ST-segment changes are of limited value in patients with suspected acute myocardial infarction (AMI) and bundle branch block or wide QRS complex. A large proportion of these patients do not suffer from an AMI, whereas those with ST-elevation myocardial infarction (STEMI) equivalent AMI benefit from an aggressive treatment. Aim of the present study was to evaluate the diagnostic information of cardiac troponin I (cTnI) in hemodynamically stable patients with wide QRS complex and suspected AMI. METHODS: In 417 out of 1818 patients presenting consecutively between 01/2007 and 12/2008 in a prospective multicenter observational study with suspected AMI a prolonged QRS duration was observed. Of these, n = 117 showed significant obstructive coronary artery disease (CAD) used as diagnostic outcome variable. cTnI was determined at admission. RESULTS: Patients with significant CAD had higher cTnI levels compared to individuals without (median 250ng/L vs. 11ng/L; p<0.01). To identify patients needing a coronary intervention, cTnI yielded an area under the receiver operator characteristics curve of 0.849. Optimized cut-offs with respect to a sensitivity driven rule-out and specificity driven rule-in strategy were established (40ng/L/96ng/L). Application of the specificity optimized cut-off value led to a positive predictive value of 71% compared to 59% if using the 99(th) percentile cut-off. The sensitivity optimized cut-off value was associated with a negative predictive value of 93% compared to 89% provided by application of the 99(th) percentile threshold. CONCLUSION: cTnI determined in hemodynamically stable patients with suspected AMI and wide QRS complex using optimized diagnostic thresholds improves rule-in and rule-out with respect to presence of a significant obstructive CAD. |
format | Online Article Text |
id | pubmed-4858235 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-48582352016-05-13 Troponin I Assay for Identification of a Significant Coronary Stenosis in Patients with Suspected Acute Myocardial Infarction and Wide QRS Complex von Jeinsen, Beatrice Tzikas, Stergios Pioro, Gerhard Palapies, Lars Zeller, Tanja Bickel, Christoph Lackner, Karl J. Baldus, Stephan Blankenberg, Stefan Muenzel, Thomas Zeiher, Andreas M. Keller, Till PLoS One Research Article BACKGROUND: Common ECG criteria such as ST-segment changes are of limited value in patients with suspected acute myocardial infarction (AMI) and bundle branch block or wide QRS complex. A large proportion of these patients do not suffer from an AMI, whereas those with ST-elevation myocardial infarction (STEMI) equivalent AMI benefit from an aggressive treatment. Aim of the present study was to evaluate the diagnostic information of cardiac troponin I (cTnI) in hemodynamically stable patients with wide QRS complex and suspected AMI. METHODS: In 417 out of 1818 patients presenting consecutively between 01/2007 and 12/2008 in a prospective multicenter observational study with suspected AMI a prolonged QRS duration was observed. Of these, n = 117 showed significant obstructive coronary artery disease (CAD) used as diagnostic outcome variable. cTnI was determined at admission. RESULTS: Patients with significant CAD had higher cTnI levels compared to individuals without (median 250ng/L vs. 11ng/L; p<0.01). To identify patients needing a coronary intervention, cTnI yielded an area under the receiver operator characteristics curve of 0.849. Optimized cut-offs with respect to a sensitivity driven rule-out and specificity driven rule-in strategy were established (40ng/L/96ng/L). Application of the specificity optimized cut-off value led to a positive predictive value of 71% compared to 59% if using the 99(th) percentile cut-off. The sensitivity optimized cut-off value was associated with a negative predictive value of 93% compared to 89% provided by application of the 99(th) percentile threshold. CONCLUSION: cTnI determined in hemodynamically stable patients with suspected AMI and wide QRS complex using optimized diagnostic thresholds improves rule-in and rule-out with respect to presence of a significant obstructive CAD. Public Library of Science 2016-05-05 /pmc/articles/PMC4858235/ /pubmed/27148734 http://dx.doi.org/10.1371/journal.pone.0154724 Text en © 2016 von Jeinsen et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article von Jeinsen, Beatrice Tzikas, Stergios Pioro, Gerhard Palapies, Lars Zeller, Tanja Bickel, Christoph Lackner, Karl J. Baldus, Stephan Blankenberg, Stefan Muenzel, Thomas Zeiher, Andreas M. Keller, Till Troponin I Assay for Identification of a Significant Coronary Stenosis in Patients with Suspected Acute Myocardial Infarction and Wide QRS Complex |
title | Troponin I Assay for Identification of a Significant Coronary Stenosis in Patients with Suspected Acute Myocardial Infarction and Wide QRS Complex |
title_full | Troponin I Assay for Identification of a Significant Coronary Stenosis in Patients with Suspected Acute Myocardial Infarction and Wide QRS Complex |
title_fullStr | Troponin I Assay for Identification of a Significant Coronary Stenosis in Patients with Suspected Acute Myocardial Infarction and Wide QRS Complex |
title_full_unstemmed | Troponin I Assay for Identification of a Significant Coronary Stenosis in Patients with Suspected Acute Myocardial Infarction and Wide QRS Complex |
title_short | Troponin I Assay for Identification of a Significant Coronary Stenosis in Patients with Suspected Acute Myocardial Infarction and Wide QRS Complex |
title_sort | troponin i assay for identification of a significant coronary stenosis in patients with suspected acute myocardial infarction and wide qrs complex |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4858235/ https://www.ncbi.nlm.nih.gov/pubmed/27148734 http://dx.doi.org/10.1371/journal.pone.0154724 |
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