title: High-sensitivity troponin and novel biomarkers for the early diagnosis of non-ST-segment elevation myocardial infarction in patients with atrial fibrillation.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of high-sensitivity troponin I (hsTnI) and other novel biomarkers for diagnosing non-ST-segment elevation myocardial infarction (NSTEMI) in patients with atrial fibrillation.
  
  
  METHODS
  In an acute chest pain cohort (N=1673), mean age 61.4±13.6 (34% female), we measured hsTnI and 13 established and novel biomarkers reflecting ischaemia, necrosis, inflammation, myocardial stress, angiogenesis on admission and after three hours in order to investigate their diagnostic accuracy for NSTEMI.
  
  
  RESULTS
  In atrial fibrillation patients (N=299) hsTnI on admission had the best discriminatory ability for NSTEMI (area under the curve 0.97) with only two novel biomarkers, copeptin and heart-type fatty acid binding protein, having area under the curve >0.70. Measured biomarkers showed comparable discriminatory ability in atrial fibrillation and non-atrial fibrillation patients. The combination of hsTnI on admission with additional biomarkers did not clinically significantly improve diagnostic performance. In atrial fibrillation patients, hsTnI concentrations ⩽21.7 ng/L (99th percentile in a healthy German cohort) on admission gave a negative predictive value of ~100% (95% confidence interval 97-100%). The combination of hsTnI on admission and absolute change of hsTnI concentration after three hours of ⩾40 ng/L resulted in a positive predictive value of 81.2% and sensitivity of 88.6%. Diagnostic accuracy was validated in an independent cohort (N=1076).
  
  
  CONCLUSIONS
  The diagnostic accuracy of hsTnI in patients with acute chest pain and atrial fibrillation is high and comparable to those without atrial fibrillation. Absolute change in hsTnI concentration enhanced diagnostic performance. No clinically relevant improvement was achieved by adding other biomarkers.
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center, Germany.
authors.forename: Nils A
authors.initials: NA
authors.lastname: Sörensen
authors.affiliation: BHF/University Centre for Cardiovascular Science, UK.
authors.forename: Anoop Sv
authors.initials: AS
authors.lastname: Shah
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center, Germany.
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Ojeda
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Peitsmeyer
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center, Germany German Center for Cardiovascular research (DZHK), Partner Site Hamburg, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.affiliation: Department of Cardiology, University Hospital Frankfurt, Germany German Center for Cardiovascular research (DZHK), Partner Site Rhein/Main, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Keller
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center, Germany German Center for Cardiovascular research (DZHK), Partner Site Hamburg, Germany.
authors.forename: Silke S
authors.initials: SS
authors.lastname: Johannsen
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Lackner
authors.affiliation: BHF/University Centre for Cardiovascular Science, UK.
authors.forename: Megan
authors.initials: M
authors.lastname: Griffiths
authors.affiliation: German Center for Cardiovascular research (DZHK), Partner Site Rhein/Main, Germany Department of Medicine 2, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.affiliation: BHF/University Centre for Cardiovascular Science, UK.
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Mills
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center, Germany German Center for Cardiovascular research (DZHK), Partner Site Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center, Germany German Center for Cardiovascular research (DZHK), Partner Site Hamburg, Germany r.schnabel@uke.de.
authors.forename: Renate B
authors.initials: RB
authors.lastname: Schnabel
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000209:etiology; D019540:Area Under Curve; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications*; D054316:Biomarkers, Pharmacological / Q000097:blood; D042241:Early Diagnosis; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005260:Female; D006020:Glycopeptides / Q000097:blood; D006801:Humans; D008297:Male; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D054316:Biomarkers, Pharmacological; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D006020:Glycopeptides; D020107:Troponin T; C048197:copeptins
keywords: Atrial fibrillation; diagnosis; high sensitivity troponin I; non-ST-segment elevation myocardial infarction