Impact of the troponin standard on the prevalence of acute myocardial infarction

被引:88
作者
Kontos, MC
Fritz, LM
Anderson, FP
Tatum, JL
Ornato, JP
Jesse, RL
机构
[1] Virginia Commonwealth Univ, Med Coll Virginia, Dept Internal Med, Div Cardiol, Richmond, VA 23298 USA
[2] Virginia Commonwealth Univ, Med Coll Virginia, Dept Emergency Med, Richmond, VA 23298 USA
[3] Virginia Commonwealth Univ, Med Coll Virginia, Dept Pathol, Div Clin Chem, Richmond, VA 23298 USA
[4] Virginia Commonwealth Univ, Med Coll Virginia, Dept Radiol, Richmond, VA 23298 USA
关键词
D O I
10.1016/S0002-8703(03)00245-X
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Recent recommendations are that troponin should replace creatine kinase (CK)-MB as the diagnostic standard for myocardial infarction (MI). The impact of this change has not been well described. Our objective was to determine the impact of a troponin standard on the prevalence of acute non-ST-elevation MI. Methods The current study was a retrospective analysis of consecutive patients without ST-segment elevation admitted for exclusion of myocardial ischemia to an inner city urban tertiary care center. All patients underwent serial marker sampling (CK, CK-MB, and cardiac troponin I [cTnl]). Patients with ST elevation consistent with acute MI (n = 130) or who did not have an 8 hour cTnI (n = 124) were excluded. The impact of 3. different cTnI diagnostic values were examined in 2181 patients: the lower limit of detectability (LLD); an optimal diagnostic value (OPT); chosen using receiver operator characteristic curve analysis; and the manufacturer's suggested upper reference level.(URL), when compared to a go Id standard CK-MB MI definition. In addition, MI prevalence was assessed using different CK-MB MI definitions and evaluated in patients with ischemic changes only. Results The prevalence CK-MB MI was 7.8%. Using the various cTnI diagnostic values, the incidence of MI increased the prevalence by 28% to 195%. Using the optimal diagnostic value for cTnI, patients with cTnI elevations not meeting, CK-MB, MI criteria had an intermediate 30-day mortality (5.4%) compared to those with CK-MB MI (7.1%). Grouping the cTnI positive, CK-MB MI negative patients with the CK-MB MI patients rather than the non-CK-MB MI patients reduced mortality for both the MI (to 5.9%) and non-MI groups (from 1.9% to 1.6%). Conclusions Changing to a troponin standard will have a substantial impact on the number of patients diagnosed with MI. The revised definition for MI will have important clinical and health care implications.
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页码:446 / 452
页数:7
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