Clinical implications of the change of cardiac troponin I levels in patients with acute chest pain - an evaluation with respect to the Universal Definition of Myocardial Infarction.
BACKGROUND
The Universal Definition of Myocardial Infarction incorporates elevated cardiac troponin levels (> 99th percentile) together with a significant rise/fall of troponins as biochemical criterion. We sought to evaluate the clinical implications of the relative change of cardiac troponin I (cTnI) levels with respect to the Universal Definition in patients with acute chest pain.


METHODS
cTnI (Stratus CS) was measured serially in 454 patients within 24h from admission. Acute myocardial infarction (AMI) was defined using the criteria adapted to the ESC/ACC consensus document, or corresponding to the Universal Definition together with prespecified cTnI changes of ≥ 20%, ≥ 50% and ≥ 100%. Follow-up was completed after 5.8 years.


RESULTS
A peak cTnI level above the 99th percentile together with a cTnI change of ≥ 20% was found in 160 patients of whom 25 did not have AMI according to the ESC/ACC criteria. These 160 patients had a significantly raised mortality (HR 2.5 [95% CI 1.7-3.8]). Higher cTnI deltas were not associated with higher mortalities but identified smaller patient cohorts at risk.


CONCLUSIONS
The Universal Definition of AMI together with a ≥ 20% cTnI change appears to improve the discrimination of acute from chronic causes of cTnI release, and allows a reliable identification of patients at risk.
Eggers
Kai M
KM
Department of Medical Sciences, Cardiology, Uppsala University Hospital, Sweden.
Jaffe
Allan S
AS
Venge
Per
P
Lindahl
Bertil
B
D000208:Acute Disease; D000368:Aged; D000787:Angina Pectoris / Q000097:blood*; D019963:Clinical Chemistry Tests / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000145:classification* / Q000175:diagnosis; D009206:Myocardium / Q000378:metabolism*; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D013997:Time Factors; D019210:Troponin I / Q000097:blood*
D019210:Troponin I