https://www.cardiologyresearchjournal.com/old-issues.php?journal=jccs&&v=3&&i=4&&y=2019&&m=May
Year: 2019
Type: article
Study design: Observational Study
Abstract: Background: The soon to be implemented state-wide introduction of highsensitivity troponin assays will allow the use of a lower threshold in identifying patients with acute myocardial infarction (AMI).Whether this assay will be too sensitive and therefore produce increased false positive results is still unclear.We aim to investigate whether a significantly elevated cardiac troponin using the current troponin assay (cTnI) will result in a clinical diagnosis of AMI.Methods: A retrospective study was performed at a Queensland Hospital with all cTnI ordered across a single month reviewed.Patients who were diagnosed with Non ST-Elevation Myocardial Infarction or ST-Elevation Myocardial Infarction were labelled as having an AMI.Results: In total, 944 investigations were ordered for 628 patients.Using the hospital laboratory cutoff of >0.040 μg/L(>99th percentile) for significance, a positive result was obtained in 105 patients (16.7%) and a negative result in 523 patients (83.3%).The positive troponin results were attributed to AMI (20%), congestive heart failure (20%), sepsis (19%), tachyarrhythmias (16.2%), renal failure (8.6%), airway disease (8.6%), pulmonary embolism (3.8%) and others -pericarditis, post angioplasty etc (3.8%).cTnI was found to be highly sensitive (100%, 95%CI 84-100%) and specific (86%, 95%CI 83-89%) for AMI.However, only 21 (3.3%) of 628 patients investigated received a diagnosis of AMI.The positive predictive value was poor (20%, 95% CI 13-29%), with the negative predictive value absolute (100%, 95% CI 99-100%).Conclusion: Current troponin assays were found to be highly sensitive and specific in diagnosing AMI.However, its poor positive predictive value may be contributed by inappropriate requests.
Authors: Aidan Yu, James Nguyen, Anthony Brown
Institutions: Royal Brisbane and Women's Hospital, Gold Coast Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4234490076