title: Introduction of high-sensitivity troponin assays: impact on myocardial infarction incidence and prognosis.
abstract: OBJECTIVE
  The study objective was to compare the incidence and prognosis of acute myocardial infarction when using high-sensitivity cardiac troponin assays instead of a standard cardiac troponin assay for the diagnosis of acute myocardial infarction.
  
  
  METHODS
  In a prospective international multicenter study, we enrolled 1124 consecutive patients presenting with suspected acute myocardial infarction. Final diagnoses were adjudicated by 2 independent cardiologists 2 times using all available clinical information: first using standard cardiac troponin levels and second using high-sensitivity cardiac troponin T levels for adjudication. Patients were followed up for a mean of 19±9 months.
  
  
  RESULTS
  The use of high-sensitivity cardiac troponin T instead of standard cardiac troponin resulted in an increase in the incidence of acute myocardial infarction from 18% to 22% (242 vs 198 patients), a relative increase of 22%. Of the 44 additional acute myocardial infarctions, 35 were type 1 acute myocardial infarctions and 9 were type 2 acute myocardial infarctions. This was accompanied by a reciprocal decrease in the incidence of unstable angina (unstable angina, 11% vs 13%). The most pronounced increase was observed in patients adjudicated with cardiac symptoms of origin other than coronary artery disease with cardiomyocyte damage (83 vs 31 patients, relative increase of 268%). Cumulative 30-month mortality rates were 4.8% in patients without acute myocardial infarction, 16.4% in patients with a small acute myocardial infarction detected only by high-sensitivity cardiac troponin T but not standard cardiac troponin, and 23.9% in patients with a moderate/large acute myocardial infarction according to standard cardiac troponin assays and high-sensitivity cardiac troponin T (P<.001).
  
  
  CONCLUSIONS
  The introduction of high-sensitivity cardiac troponin assays leads to only a modest increase in the incidence of acute myocardial infarction. The novel sensitive assays identify an additional high-risk group of patients with increased mortality, therefore appropriately classified with acute myocardial infarction (Advantageous Predictors of Acute Coronary Syndromes Evaluation; NCT00470587).
authors.affiliation: Department of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.forename: Miriam
authors.initials: M
authors.lastname: Reiter
authors.forename: Stephan
authors.initials: S
authors.lastname: Steuer
authors.forename: Stefano
authors.initials: S
authors.lastname: Bassetti
authors.forename: Cathrin
authors.initials: C
authors.lastname: Balmelli
authors.forename: Katrin
authors.initials: K
authors.lastname: Winkler
authors.forename: Sabine
authors.initials: S
authors.lastname: Kurz
authors.forename: Claudia
authors.initials: C
authors.lastname: Stelzig
authors.forename: Michael
authors.initials: M
authors.lastname: Freese
authors.forename: Beatrice
authors.initials: B
authors.lastname: Drexler
authors.forename: Philip
authors.initials: P
authors.lastname: Haaf
authors.forename: Christa
authors.initials: C
authors.lastname: Zellweger
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D014336:Troponin / Q000097:blood; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D014336:Troponin; D020107:Troponin T