title: Troponin I Assay for Identification of a Significant Coronary Stenosis in Patients with Suspected Acute Myocardial Infarction and Wide QRS Complex.
abstract: Common ECG criteria such as ST-segment changes are of limited value in patients with suspected acute myocardial infarction (AMI) and bundle branch block or wide QRS complex. A large proportion of these patients do not suffer from an AMI, whereas those with ST-elevation myocardial infarction (STEMI) equivalent AMI benefit from an aggressive treatment. Aim of the present study was to evaluate the diagnostic information of cardiac troponin I (cTnI) in hemodynamically stable patients with wide QRS complex and suspected AMI.
  
  
  
  In 417 out of 1818 patients presenting consecutively between 01/2007 and 12/2008 in a prospective multicenter observational study with suspected AMI a prolonged QRS duration was observed. Of these, n = 117 showed significant obstructive coronary artery disease (CAD) used as diagnostic outcome variable. cTnI was determined at admission.
  
  
  
  Patients with significant CAD had higher cTnI levels compared to individuals without (median 250ng/L vs. 11ng/L; p<0.01). To identify patients needing a coronary intervention, cTnI yielded an area under the receiver operator characteristics curve of 0.849. Optimized cut-offs with respect to a sensitivity driven rule-out and specificity driven rule-in strategy were established (40ng/L/96ng/L). Application of the specificity optimized cut-off value led to a positive predictive value of 71% compared to 59% if using the 99th percentile cut-off. The sensitivity optimized cut-off value was associated with a negative predictive value of 93% compared to 89% provided by application of the 99th percentile threshold.
  
  
  
  cTnI determined in hemodynamically stable patients with suspected AMI and wide QRS complex using optimized diagnostic thresholds improves rule-in and rule-out with respect to presence of a significant obstructive CAD.
authors.affiliation: Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt, Germany.
authors.forename: Beatrice
authors.initials: B
authors.lastname: von Jeinsen
authors.affiliation: 3rd Department of Cardiology, Aristotle University of Thessaloniki, Ippokrateio Hospital, Thessaloniki, Greece.|Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Stergios
authors.initials: S
authors.lastname: Tzikas
authors.affiliation: Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Pioro
authors.affiliation: Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Palapies
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany.|German Centre for Cardiovascular Research (DZHK), Berlin, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.affiliation: Department of Internal Medicine, Federal Armed Forces Hospital, Koblenz, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bickel
authors.affiliation: Department of Laboratory Medicine, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Lackner
authors.affiliation: Department of Internal Medicine III, University of Cologne, Köln, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
authors.affiliation: Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany.|German Centre for Cardiovascular Research (DZHK), Berlin, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: Department of Internal Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany.|German Centre for Cardiovascular Research (DZHK), Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Muenzel
authors.affiliation: Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt, Germany.|German Centre for Cardiovascular Research (DZHK), Berlin, Germany.
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Zeiher
authors.affiliation: Division of Cardiology, Department of Internal Medicine III, Goethe University Frankfurt, Frankfurt, Germany.|German Centre for Cardiovascular Research (DZHK), Berlin, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Keller
mesh_terms: D000368:Aged; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D010343:Patient Admission; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I