title: Interpretation of positive troponin results among patients with and without myocardial infarction.
abstract: Measuring cardiac troponins is integral to diagnosing acute myocardial infarction (AMI); however, troponins may be elevated without AMI, and the use of multiple different assays confounds comparisons. We considered characteristics and serial troponin values in emergency department chest pain patients with and without AMI to interpret troponin excursions. We compared serial troponin in 124 AMI and non-AMI patients from the observational Performance of Triage Cardiac Markers in the Clinical Setting (PEARL) study who presented with chest pain and had at least one troponin value exceeding the 99th percentile of normal. Because 8 assays were used during data collection, we employed a method of scaling the troponin value to the corresponding assay's 99th percentile upper reference limit to standardize the results. In 81 AMI patients, 96% had elevated troponin at the first test following initial elevation, compared to 73% of the 43 non-AMI patients (P< 0.001). Scaling troponin to the 99th percentile of normal yielded a median value that was 4.8 [2.2, 14.1] times higher than the 99th percentile cutpoint among AMI patients, compared to 2.3 [1.5, 6.5] times higher among non-AMI patients (P= 0.04). The rise in serial scaled troponin values distinguished the AMI patients. Scaling to the 99th percentile was useful for comparing troponin when different assays were utilized.
authors.affiliation: Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough).
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Tecson
authors.affiliation: Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough).
authors.forename: William
authors.initials: W
authors.lastname: Arnold
authors.affiliation: Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough).
authors.forename: Tyler
authors.initials: T
authors.lastname: Barrett
authors.affiliation: Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough).
authors.forename: Robert
authors.initials: R
authors.lastname: Birkhahn
authors.affiliation: Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough).
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.affiliation: Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough).
authors.forename: Christopher
authors.initials: C
authors.lastname: DeFilippi
authors.affiliation: Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough).
authors.forename: Gary
authors.initials: G
authors.lastname: Headden
authors.affiliation: Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough).
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough).
authors.forename: Michael
authors.initials: M
authors.lastname: Reed
authors.affiliation: Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough).
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
authors.affiliation: Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough).
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Schussler
authors.affiliation: Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough).
authors.forename: Stephen
authors.initials: S
authors.lastname: Smith
authors.affiliation: Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough).
authors.forename: Martin P
authors.initials: MP
authors.lastname: Than
authors.affiliation: Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough).
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough