[Diagnoses and increased levels of troponin T among discharged patients].
BACKGROUND
New criteria for diagnosing acute myocardial infarction, in which the cardiac troponin T or I plays a central role, have recently been proposed. We wanted to estimate what an application of these criteria would have meant for the diagnoses given patients discharged from our hospital in 2000.


METHODS
From the hospital data bases, 3,461 in-hospital patients were identified in whom troponin T levels in blood had been determined. Maximal troponin T levels and diagnoses on discharge were recorded. Only one diagnosis was used for each patient. The diagnoses were selected in a priority order favouring those diseases that are known most often to cause increased troponin T levels, starting with the codes for acute myocardial infarction.


RESULTS
By applying the new criteria, the number of patients with myocardial infarction was estimated to increase 17%, 33% and 61% depending on the decision level for troponin T used, 0.20, 0.10 or 0.03 microgram/l, respectively. Congestive heart failure and atrial fibrillation were the most frequent cardiac diagnoses in patients with increased troponin T level without evidence of acute coronary syndromes. Other, non-cardiac diagnoses included renal diseases, sepsis, and acute lung diseases.


CONCLUSIONS
Application of the new diagnostic criteria will markedly increase the recorded incidence of acute myocardial infarction. The number of positive troponin T values in patients without acute coronary syndromes will increase progressively by lowering the diagnostic decision level of troponin T.
Strømme
J H
JH
Klinisk kjemisk avdeling Laboratoriemedisinsk divisjon, Ullevål universitetssykehus 0407 Oslo. j.h.stromme@ioks.uio.no
Halvorsen
S
S
Frederichsen
P
P
D001281:Atrial Fibrillation / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D003327:Coronary Disease / Q000097:blood*; D006331:Heart Diseases / Q000097:blood*; D006333:Heart Failure / Q000097:blood; D006801:Humans; D015994:Incidence; D016347:Medical Records Systems, Computerized; D009203:Myocardial Infarction / Q000097:blood*; D009664:Norway / Q000453:epidemiology; D010351:Patient Discharge; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T