Faculty Collaboration Database

Cardiac troponin changes to distinguish type 1 and type 2 myocardial infarction and 180-day mortality risk. Eur Heart J Acute Cardiovasc Care 2014 Dec;3(4):317-25

Date

06/27/2014

Pubmed ID

24965188

DOI

10.1177/2048872614538411

Scopus ID

2-s2.0-84965091397 (requires institutional sign-in at Scopus site)   80 Citations

Abstract

AIMS: To determine the ability of serial cardiac troponin (cTnI) changes (delta) to distinguish type 1 and type 2 myocardial infarction (MI) (excluding all ST-segment elevation MIs (STEMIs)) and describe the diagnostic accuracy and 180-day mortality in MI versus no-MI patients.

METHODS AND RESULTS: Serial cTnIs were measured in 1112 consecutive patients without STEMI and within 6h of presentation to a United States emergency department: 856 (77%) with no MI, 66 (6%) type 1 MI, and 190 (17%) type 2 MI. Of the 0 to 3h and 0 to 6h absolute and relative cTnI changes, only the distribution of absolute change from 0 to 6h was significantly different between type 1 and type 2 MI: median (interquartile range) 311 (1430) ng/l vs. 80 (330) ng/l, p=0.03. Neither the absolute concentration change nor the absolute percent change from either 0 h to 3h (areas under the curves (AUCs) 0.57 and 0.54 respectively) or 0 h to 6h (AUCs 0.60 and 0.51) improved on the performance of the individual cTnI results at 3h (AUC 0.60) or 6h (AUC 0.62), respectively. After adjusting for age, and histories of heart failure and renal insufficiency, those with type 2 MI (hazard ratio 2.9, 95% confidence interval (CI) 1.4-5.9, p=0.004) and those with no index MI and cTnI(max0-6h) > 34 ng/l (2.5, CI 1.1-6.0, p=0.04) had increased risk of death within 180 days compared with those with no MI and cTnI(max 0-6h) ≤ 34 ng/l.

CONCLUSION: Delta cTnI did not aid in distinguishing type 1 MI from the more common type 2 MI. Patients diagnosed with type 2 MIs, which represented more than half of all index MIs, had increased risk of death after discharge.

Author List

Sandoval Y, Thordsen SE, Smith SW, Schulz KM, Murakami MM, Pearce LA, Apple FS

Author

Sarah E. Thordsen MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Diagnosis, Differential
Female
Hospitalization
Humans
Male
Middle Aged
Myocardial Infarction
ROC Curve
Retrospective Studies
Risk Assessment
Survival Analysis
Troponin C