Sensitive troponin assays in patients with suspected acute coronary syndrome: Results from the multicenter rule out myocardial infarction using computer assisted tomography II trial

James L. Januzzi, Umesh Sharma, Pearl Zakroysky, Quynh A. Truong, Pamela K. Woodard, J. Hector Pope, Thomas Hauser, Thomas Mayrhofer, J. Toby Nagurney, David Schoenfeld, W. Frank Peacock, Jerome L. Fleg, Stephen Wiviott, Peter Pang, James Udelson, Udo Hoffmann

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Abstract

Background Sensitive troponin (Tn) assays have been developed for the evaluation of patients with suspected acute coronary syndrome (ACS). We sought to compare the performance of a commercially available sensitive Tn I (sTnI) and precommercial highly sTnI (hsTnI) method to conventional Tn (cTn) assays. Methods Among patients with acute chest pain but normal cTn in the emergency department of 6 centers, sTnI and hsTnI were measured at baseline, 2 and 4 hours after presentation. Diagnostic accuracy of sTnI and hsTnI relative to cTn for diagnosis during index hospitalization as well as their associations with coronary artery disease in patients randomized to coronary computed tomographic angiography (CTA) was assessed. Results Overall, 322 patients were enrolled, of whom 161 had a CTA; 28 had ACS (8.7%), including 21 with unstable angina pectoris (UAP). Both sTnI and hsTnI values at baseline and second draw had significantly higher sensitivity for ACS and UAP than cTn and had significantly greater area under the receiver operator characteristic curve than cTn at first and second draws. Compared with cTn, 29% of ACS cases previously categorized as UAP were reclassified to acute myocardial infarction with sTnI or hsTnI. An hsTnI below limit of detection had 100% negative predictive value for ACS or significant coronary artery stenosis in those randomized to CTA. Conclusions In patients with acute chest discomfort, use of sTnI and hsTnI methods led to significant improvement in the early diagnostic accuracy for ACS, reclassifying one-third of UAP to myocardial infarction. Very low values for hsTnI excluded underlying coronary artery disease.

Original languageEnglish (US)
Pages (from-to)572-578.e1
JournalAmerican Heart Journal
Volume169
Issue number4
DOIs
StatePublished - Apr 1 2015

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Troponin
Acute Coronary Syndrome
Myocardial Infarction
Unstable Angina
Tomography
Angiography
Coronary Artery Disease
Troponin I
Coronary Stenosis
Acute Pain
Chest Pain
Limit of Detection
Hospital Emergency Service
Hospitalization
Thorax

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Sensitive troponin assays in patients with suspected acute coronary syndrome : Results from the multicenter rule out myocardial infarction using computer assisted tomography II trial. / Januzzi, James L.; Sharma, Umesh; Zakroysky, Pearl; Truong, Quynh A.; Woodard, Pamela K.; Pope, J. Hector; Hauser, Thomas; Mayrhofer, Thomas; Nagurney, J. Toby; Schoenfeld, David; Peacock, W. Frank; Fleg, Jerome L.; Wiviott, Stephen; Pang, Peter; Udelson, James; Hoffmann, Udo.

In: American Heart Journal, Vol. 169, No. 4, 01.04.2015, p. 572-578.e1.

Research output: Contribution to journalArticle

Januzzi, JL, Sharma, U, Zakroysky, P, Truong, QA, Woodard, PK, Pope, JH, Hauser, T, Mayrhofer, T, Nagurney, JT, Schoenfeld, D, Peacock, WF, Fleg, JL, Wiviott, S, Pang, P, Udelson, J & Hoffmann, U 2015, 'Sensitive troponin assays in patients with suspected acute coronary syndrome: Results from the multicenter rule out myocardial infarction using computer assisted tomography II trial', American Heart Journal, vol. 169, no. 4, pp. 572-578.e1. https://doi.org/10.1016/j.ahj.2014.12.023
Januzzi, James L. ; Sharma, Umesh ; Zakroysky, Pearl ; Truong, Quynh A. ; Woodard, Pamela K. ; Pope, J. Hector ; Hauser, Thomas ; Mayrhofer, Thomas ; Nagurney, J. Toby ; Schoenfeld, David ; Peacock, W. Frank ; Fleg, Jerome L. ; Wiviott, Stephen ; Pang, Peter ; Udelson, James ; Hoffmann, Udo. / Sensitive troponin assays in patients with suspected acute coronary syndrome : Results from the multicenter rule out myocardial infarction using computer assisted tomography II trial. In: American Heart Journal. 2015 ; Vol. 169, No. 4. pp. 572-578.e1.
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abstract = "Background Sensitive troponin (Tn) assays have been developed for the evaluation of patients with suspected acute coronary syndrome (ACS). We sought to compare the performance of a commercially available sensitive Tn I (sTnI) and precommercial highly sTnI (hsTnI) method to conventional Tn (cTn) assays. Methods Among patients with acute chest pain but normal cTn in the emergency department of 6 centers, sTnI and hsTnI were measured at baseline, 2 and 4 hours after presentation. Diagnostic accuracy of sTnI and hsTnI relative to cTn for diagnosis during index hospitalization as well as their associations with coronary artery disease in patients randomized to coronary computed tomographic angiography (CTA) was assessed. Results Overall, 322 patients were enrolled, of whom 161 had a CTA; 28 had ACS (8.7{\%}), including 21 with unstable angina pectoris (UAP). Both sTnI and hsTnI values at baseline and second draw had significantly higher sensitivity for ACS and UAP than cTn and had significantly greater area under the receiver operator characteristic curve than cTn at first and second draws. Compared with cTn, 29{\%} of ACS cases previously categorized as UAP were reclassified to acute myocardial infarction with sTnI or hsTnI. An hsTnI below limit of detection had 100{\%} negative predictive value for ACS or significant coronary artery stenosis in those randomized to CTA. Conclusions In patients with acute chest discomfort, use of sTnI and hsTnI methods led to significant improvement in the early diagnostic accuracy for ACS, reclassifying one-third of UAP to myocardial infarction. Very low values for hsTnI excluded underlying coronary artery disease.",
author = "Januzzi, {James L.} and Umesh Sharma and Pearl Zakroysky and Truong, {Quynh A.} and Woodard, {Pamela K.} and Pope, {J. Hector} and Thomas Hauser and Thomas Mayrhofer and Nagurney, {J. Toby} and David Schoenfeld and Peacock, {W. Frank} and Fleg, {Jerome L.} and Stephen Wiviott and Peter Pang and James Udelson and Udo Hoffmann",
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T1 - Sensitive troponin assays in patients with suspected acute coronary syndrome

T2 - Results from the multicenter rule out myocardial infarction using computer assisted tomography II trial

AU - Januzzi, James L.

AU - Sharma, Umesh

AU - Zakroysky, Pearl

AU - Truong, Quynh A.

AU - Woodard, Pamela K.

AU - Pope, J. Hector

AU - Hauser, Thomas

AU - Mayrhofer, Thomas

AU - Nagurney, J. Toby

AU - Schoenfeld, David

AU - Peacock, W. Frank

AU - Fleg, Jerome L.

AU - Wiviott, Stephen

AU - Pang, Peter

AU - Udelson, James

AU - Hoffmann, Udo

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N2 - Background Sensitive troponin (Tn) assays have been developed for the evaluation of patients with suspected acute coronary syndrome (ACS). We sought to compare the performance of a commercially available sensitive Tn I (sTnI) and precommercial highly sTnI (hsTnI) method to conventional Tn (cTn) assays. Methods Among patients with acute chest pain but normal cTn in the emergency department of 6 centers, sTnI and hsTnI were measured at baseline, 2 and 4 hours after presentation. Diagnostic accuracy of sTnI and hsTnI relative to cTn for diagnosis during index hospitalization as well as their associations with coronary artery disease in patients randomized to coronary computed tomographic angiography (CTA) was assessed. Results Overall, 322 patients were enrolled, of whom 161 had a CTA; 28 had ACS (8.7%), including 21 with unstable angina pectoris (UAP). Both sTnI and hsTnI values at baseline and second draw had significantly higher sensitivity for ACS and UAP than cTn and had significantly greater area under the receiver operator characteristic curve than cTn at first and second draws. Compared with cTn, 29% of ACS cases previously categorized as UAP were reclassified to acute myocardial infarction with sTnI or hsTnI. An hsTnI below limit of detection had 100% negative predictive value for ACS or significant coronary artery stenosis in those randomized to CTA. Conclusions In patients with acute chest discomfort, use of sTnI and hsTnI methods led to significant improvement in the early diagnostic accuracy for ACS, reclassifying one-third of UAP to myocardial infarction. Very low values for hsTnI excluded underlying coronary artery disease.

AB - Background Sensitive troponin (Tn) assays have been developed for the evaluation of patients with suspected acute coronary syndrome (ACS). We sought to compare the performance of a commercially available sensitive Tn I (sTnI) and precommercial highly sTnI (hsTnI) method to conventional Tn (cTn) assays. Methods Among patients with acute chest pain but normal cTn in the emergency department of 6 centers, sTnI and hsTnI were measured at baseline, 2 and 4 hours after presentation. Diagnostic accuracy of sTnI and hsTnI relative to cTn for diagnosis during index hospitalization as well as their associations with coronary artery disease in patients randomized to coronary computed tomographic angiography (CTA) was assessed. Results Overall, 322 patients were enrolled, of whom 161 had a CTA; 28 had ACS (8.7%), including 21 with unstable angina pectoris (UAP). Both sTnI and hsTnI values at baseline and second draw had significantly higher sensitivity for ACS and UAP than cTn and had significantly greater area under the receiver operator characteristic curve than cTn at first and second draws. Compared with cTn, 29% of ACS cases previously categorized as UAP were reclassified to acute myocardial infarction with sTnI or hsTnI. An hsTnI below limit of detection had 100% negative predictive value for ACS or significant coronary artery stenosis in those randomized to CTA. Conclusions In patients with acute chest discomfort, use of sTnI and hsTnI methods led to significant improvement in the early diagnostic accuracy for ACS, reclassifying one-third of UAP to myocardial infarction. Very low values for hsTnI excluded underlying coronary artery disease.

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