Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay

Liebetrau, Christoph; Weber, Michael; Tzikas, Stergios; Palapies, Lars; Möllmann, Helge; Pioro, Gerhard; Zeller, Tanja; Beiras-Fernández, Andrés; Bickel, Christoph; Zeiher, Andreas M.; Lackner, Karl J.; Baldus, Stephan; Nef, Holger; Blankenberg, Stefan; Hamm, Christian W.; Münzel, Thomas; Keller, Till

doi:10.1186/s12916-015-0410-8

Cited by 19 publications

(11 citation statements)

References 28 publications

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“…As opposed to levels of troponin I elevation found in our study, cardiac causes of troponin elevation are usually associated with higher troponin I levels [18].…”

Section: Discussioncontrasting

confidence: 99%

Impact of troponin I on outcome of ischemic stroke patients

Budinčević

Sremec²,

Črnac³

et al. 2017

Romanian Journal of Internal Medicine

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Introduction. Stroke is one of the leading causes of morbidity and mortality. Cardiac troponins have been found to be increased in other conditions apart from the cardiac diseases, such as stroke. The aim of the study was to assess the correlation between elevated troponin I levels and stroke outcome.Methods. This retrospective study included 198 acute ischemic stroke patients in whom troponin I levels have been obtained at admission. Exclusion criteria were concomitant acute coronary syndrome, congestive heart failure, pulmonary embolism, renal failure, rhabdomyolysis and septic conditions.Results. There was a statistically significant difference in the proportion of deaths during hospitalization (p = 0.041) and modified Rankin Scale scores (p = 0.016) between the group of patients with elevated troponin I levels and the control group. Prior ischemic strokes were more common in the group with elevated troponin I levels (p = 0.032). No other differences were observed.Conclusions. Our study showed that patients with elevated initial troponin I levels are associated with unfavorable outcome or death. Stroke may be associated with mild elevation of troponin levels, contrary to higher levels which are usually related to other conditions.

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“…As opposed to levels of troponin I elevation found in our study, cardiac causes of troponin elevation are usually associated with higher troponin I levels [18].…”

Section: Discussioncontrasting

confidence: 99%

Impact of troponin I on outcome of ischemic stroke patients

Budinčević

Sremec²,

Črnac³

et al. 2017

Romanian Journal of Internal Medicine

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“…Similarly, the median times between the fi rst and second test following the initial elevation, as well as the second and third test following the initial elevation, did not diff er ( P = 0.95 and 0.37, respectively). Th e median number of troponin tests performed per patient until the fi rst elevation occurred was 1 for both AMI and non-AMI patients; however, the median total number of tests performed for AMI patients was 4 [3,5], compared to 3 [2,4] for non-AMI patients ( P = 0.01). Of the 124 patients who had at least one elevated troponin, 114 (91.9%) had at least one subsequent test performed.…”

Section: Resultsmentioning

confidence: 98%

Interpretation of Positive Troponin Results Among Patients with and Without Myocardial Infarction

Tecson

Arnold

Barrett

et al. 2017

Baylor University Medical Center Proceedings

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Measuring cardiac troponins is integral to diagnosing acute myocardial infarction (AMI); however, troponins may be elevated without AMI, and the use of multiple different assays confounds comparisons. We considered characteristics and serial troponin values in emergency department chest pain patients with and without AMI to interpret troponin excursions. We compared serial troponin in 124 AMI and non-AMI patients from the observational Performance of Triage Cardiac Markers in the Clinical Setting (PEARL) study who presented with chest pain and had at least one troponin value exceeding the 99th percentile of normal. Because 8 assays were used during data collection, we employed a method of scaling the troponin value to the corresponding assay's 99th percentile upper reference limit to standardize the results. In 81 AMI patients, 96% had elevated troponin at the first test following initial elevation, compared to 73% of the 43 non-AMI patients ( P < 0.001). Scaling troponin to the 99th percentile of normal yielded a median value that was 4.8 [2.2, 14.1] times higher than the 99th percentile cutpoint among AMI patients, compared to 2.3 [1.5, 6.5] times higher among non-AMI patients ( P = 0.04). The rise in serial scaled troponin values distinguished the AMI patients. Scaling to the 99th percentile was useful for comparing troponin when different assays were utilized. H igh-sensitivity troponin I testing has been shown to improve the early diagnosis of acute myocardial infarction (AMI) and aid with risk stratifi cation ( 1 -3 ). Investigators using a registry in Australia and New Zealand determined that high-sensitivity troponin I testing was associated with fewer in-hospital adverse events for patients hospitalized with possible acute coronary syndrome ( 4 ). Th ere are multiple non-AMI clinical scenarios, however, where troponin may exceed the 99th percentile, including renal failure, stroke, heart failure, pulmonary embolism, sepsis, and hypertension ( 5 ). We capitalized on a data set of chest pain patients who had serial troponin assays performed, had at least one positive value, and had central adjudication of the outcome of AMI. We compared the characteristics, as well as the dynamic rise and fall of troponin, in this group of patients to better understand how to quantitatively evaluate the excursion of troponin and relate it to the confi rmed diagnosis of AMI.

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“…Liebetrau et al proposed diagnostic approach for AMI in patients with atrial fibrillation and symptoms suggestive of AMI. The specificity-optimized cut-off values higher than the 99th percentile concentration (0.032 ng/mL) and additional use of the 3-hour change in troponin concentration lead to a positive predictive value of more than 95%, facilitating identification of patients with AMI [ 28 ]. Patient 2 had atrial fibrillation that lasted for few minutes and resolved spontaneously.…”

Section: Discussionmentioning

confidence: 99%

Amphetamine Abuse Related Acute Myocardial Infarction

Sinha

Lewis

Kumar

et al. 2016

Case Reports in Cardiology

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Amphetamine abuse is a global problem. The cardiotoxic manifestations like acute myocardial infarction (AMI), heart failure, or arrhythmia related to misuse of amphetamine and its synthetic derivatives have been documented but are rather rare. Amphetamine-related AMI is even rarer. We report two cases of men who came to emergency department (ED) with chest pain, palpitation, or seizure and were subsequently found to have myocardial infarction associated with the use of amphetamines. It is crucial that, with increase in amphetamine abuse, clinicians are aware of this potentially dire complication. Patients with low to intermediate risk for coronary artery disease with atypical presentation may benefit from obtaining detailed substance abuse history and urine drug screen if deemed necessary.

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Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay

Cited by 19 publications

References 28 publications

Impact of troponin I on outcome of ischemic stroke patients

Impact of troponin I on outcome of ischemic stroke patients

Interpretation of Positive Troponin Results Among Patients with and Without Myocardial Infarction

Amphetamine Abuse Related Acute Myocardial Infarction

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