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Myocardial Infarction Risk Stratification With a Single Measurement of High-Sensitivity Troponin I.

Publication ,  Journal Article
Sandoval, Y; Nowak, R; deFilippi, CR; Christenson, RH; Peacock, WF; McCord, J; Limkakeng, AT; Sexter, A; Apple, FS
Published in: J Am Coll Cardiol
July 23, 2019

BACKGROUND: Limited data exist on rapid risk-stratification strategies using the U.S. Food and Drug Administration-cleared high-sensitivity cardiac troponin I (hs-cTnI) assays. OBJECTIVES: This study sought to examine single measurement hs-cTnI to identify patients at low and high risk for acute myocardial infarction (MI). METHODS: This was a prospective, multicenter, observational study of patients with suspected acute MI enrolled across 29 U.S. sites with hs-cTnI measured using the Atellica IM TnIH and ADVIA Centaur TNIH (Siemens Healthineers) assays. To identify low-risk patients, sensitivities and negative predictive values (NPVs) for acute MI and MI or death at 30 days were examined across baseline hs-cTnI concentrations. To identify high-risk patients, positive predictive values and specificities for acute MI were evaluated. RESULTS: Among 2,212 patients, acute MI occurred in 12%. The limits of detection or quantitation resulted in excellent sensitivities (range 98.6% to 99.6%) and NPVs (range 99.5% to 99.8%) for acute MI or death at 30 days across both assays. An optimized threshold of <5 ng/l identified almost one-half of all patients as low risk, with sensitivities of 98.6% (95% confidence interval: 97.2% to 100%) and NPVs of 99.6% (95% confidence interval: 99.2% to 99.9%) for acute MI or death at 30 days across both assays. For high-risk patients, hs-cTnI ≥120 ng/l resulted in positive predictive values for acute MI of ≥70%. CONCLUSIONS: Recognizing the continuous relationship between baseline hs-cTnI and risk for adverse events, using 2 Food and Drug Administration-cleared hs-cTnI assays, an optimized threshold of <5 ng/l safely identified almost one-half of all patients as low risk at presentation, with hs-cTnI ≥120 ng/l identifying high-risk patients.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

July 23, 2019

Volume

74

Issue

3

Start / End Page

271 / 282

Location

United States

Related Subject Headings

  • Troponin I
  • Sensitivity and Specificity
  • Risk Assessment
  • Prospective Studies
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cardiovascular System & Hematology
 

Citation

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Sandoval, Y., Nowak, R., deFilippi, C. R., Christenson, R. H., Peacock, W. F., McCord, J., … Apple, F. S. (2019). Myocardial Infarction Risk Stratification With a Single Measurement of High-Sensitivity Troponin I. J Am Coll Cardiol, 74(3), 271–282. https://doi.org/10.1016/j.jacc.2019.05.058
Sandoval, Yader, Richard Nowak, Christopher R. deFilippi, Robert H. Christenson, W Frank Peacock, James McCord, Alexander T. Limkakeng, Anne Sexter, and Fred S. Apple. “Myocardial Infarction Risk Stratification With a Single Measurement of High-Sensitivity Troponin I.J Am Coll Cardiol 74, no. 3 (July 23, 2019): 271–82. https://doi.org/10.1016/j.jacc.2019.05.058.
Sandoval Y, Nowak R, deFilippi CR, Christenson RH, Peacock WF, McCord J, et al. Myocardial Infarction Risk Stratification With a Single Measurement of High-Sensitivity Troponin I. J Am Coll Cardiol. 2019 Jul 23;74(3):271–82.
Sandoval, Yader, et al. “Myocardial Infarction Risk Stratification With a Single Measurement of High-Sensitivity Troponin I.J Am Coll Cardiol, vol. 74, no. 3, July 2019, pp. 271–82. Pubmed, doi:10.1016/j.jacc.2019.05.058.
Sandoval Y, Nowak R, deFilippi CR, Christenson RH, Peacock WF, McCord J, Limkakeng AT, Sexter A, Apple FS. Myocardial Infarction Risk Stratification With a Single Measurement of High-Sensitivity Troponin I. J Am Coll Cardiol. 2019 Jul 23;74(3):271–282.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

July 23, 2019

Volume

74

Issue

3

Start / End Page

271 / 282

Location

United States

Related Subject Headings

  • Troponin I
  • Sensitivity and Specificity
  • Risk Assessment
  • Prospective Studies
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cardiovascular System & Hematology