title: Identification of acute myocardial infarction in patients with atrial fibrillation and chest pain with a contemporary sensitive troponin I assay.
abstract: BACKGROUND
  The introduction of modern troponin assays has facilitated diagnosis of acute myocardial infarction due to improved sensitivity with corresponding loss of specificity. Atrial fibrillation (AF) is associated with elevated levels of troponin. The aim of the present study was to evaluate the diagnostic performance of troponin I in patients with suspected acute coronary syndrome and chronic AF.
  
  
  METHODS
  Contemporary sensitive troponin I was assayed in a derivation cohort of 90 patients with suspected acute coronary syndrome and chronic AF to establish diagnostic cut-offs. These thresholds were validated in an independent cohort of 314 patients with suspected myocardial infarction and AF upon presentation. Additionally, changes in troponin I concentration within 3 hours were used.
  
  
  RESULTS
  In the derivation cohort, optimized thresholds with respect to a rule-out strategy with high sensitivity and a rule-in strategy with high specificity were established. In the validation cohort, application of the rule-out cut-off led to a negative predictive value of 97 %. The rule-in cut-off was associated with a positive predictive value of 88 % compared with 71 % if using the 99th percentile cut-off. In patients with troponin I levels above the specificity-optimized threshold, additional use of the 3-hour change in absolute/relative concentration resulted in a further improved positive predictive value of 96 %/100 %.
  
  
  CONCLUSIONS
  Troponin I concentration and the 3-hour change in its concentration provide valid diagnostic information in patients with suspected myocardial infarction and chronic AF. With regard to AF-associated elevation of troponin levels, application of diagnostic cut-offs other than the 99th percentile might be beneficial.
authors.affiliation: Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany. c.liebetrau@kerckhoff-klinik.de.|DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. c.liebetrau@kerckhoff-klinik.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Liebetrau
authors.affiliation: Department of Internal Medicine II, Hospital Darmstadt-Dieburg, Groß-Umstadt, Germany. m.weber@kreiskliniken-dadi.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.affiliation: 3rd Department of Cardiology, Aristotle University of Thessaloniki, Ippokrateio Hospital, Thessaloniki, Greece. tzikas@gmail.com.|Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany. tzikas@gmail.com.
authors.forename: Stergios
authors.initials: S
authors.lastname: Tzikas
authors.affiliation: DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. Lars.Palapies@kgu.de.|Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt am Main, Germany. Lars.Palapies@kgu.de.
authors.forename: Lars
authors.initials: L
authors.lastname: Palapies
authors.affiliation: Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany. h.moellmann@kerckhoff-klinik.de.|DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. h.moellmann@kerckhoff-klinik.de.
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.affiliation: DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. gerhard.pioro@gmx.de.|Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany. gerhard.pioro@gmx.de.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Pioro
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany. t.zeller@uke.de.|DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Hamburg, Germany. t.zeller@uke.de.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.affiliation: Department of Cardiothoracic Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany. Andres.Beiras@kgu.de.
authors.forename: Andres
authors.initials: A
authors.lastname: Beiras-Fernandez
authors.affiliation: DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. christophbickel@bundeswehr.org.|Department of Internal Medicine, Federal Armed Forces Hospital, Koblenz, Germany. christophbickel@bundeswehr.org.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bickel
authors.affiliation: DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. zeiher@em.uni-frankfurt.de.|Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt am Main, Germany. zeiher@em.uni-frankfurt.de.
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Zeiher
authors.affiliation: Department of Laboratory Medicine, University Medical Center, Johannes Gutenberg University, Mainz, Germany. Karl.Lackner@unimedizin-mainz.de.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Lackner
authors.affiliation: Department of Internal Medicine III, University of Cologne, Cologne, Germany. stephan.baldus@uk-koeln.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
authors.affiliation: Department of Cardiology, University of Giessen, Giessen, Germany. holger.nef@me.com.
authors.forename: Holger M
authors.initials: HM
authors.lastname: Nef
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany. s.blankenberg@uke.de.|DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Hamburg, Germany. s.blankenberg@uke.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany. c.hamm@kerckhoff-klinik.de.|DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. c.hamm@kerckhoff-klinik.de.|Department of Cardiology, University of Giessen, Giessen, Germany. c.hamm@kerckhoff-klinik.de.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.affiliation: DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. tmuenzel@uni-mainz.de.|Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany. tmuenzel@uni-mainz.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.affiliation: DZHK (German Centre for Cardiovascular Research), partner site RheinMain, Frankfurt am Main, Germany. keller@chestpain.de.|Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt am Main, Germany. keller@chestpain.de.
authors.forename: Till
authors.initials: T
authors.lastname: Keller
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D012016:Reference Values; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I