Ann Lab Med.  2020 Nov;40(6):474-480. 10.3343/alm.2020.40.6.474.

Absolute Change in High-Sensitivity Cardiac Troponin I at Three Hours After Presentation is Useful for Diagnosing Acute Myocardial Infarction in the Emergency Department

• Kim JW
• Kim H
• Yun YM
• Lee KR
• Kim HJ

• KMID: 2507793
• DOI: http://doi.org/10.3343/alm.2020.40.6.474

Abstract

Background
A rise and/or fall in cardiac troponin value with at least one value above the 99th percentile upper reference limit is essential for acute myocardial infarction (AMI) diagnosis. We evaluated the clinical usefulness of serial high-sensitivity cardiac troponin I (hs-cTnI) measurements in AMI diagnosis, in terms of the predictability of absolute and relative changes.
Methods
For this retrospective, forward observational study, we enrolled 281 patients older than 18 years who presented with chest pain at the emergency department (ED) between August 2015 and December 2016. The patients were grouped as AMI and nonAMI, and 73 (26%) were diagnosed as having AMI. Hs-cTnI (Abbott Diagnostics, Abbott Park, IL, USA) was measured at presentation and 3 hours later. We assessed the diagnostic performance of the absolute and relative changes in hs-cTnI.
Results
The cut-off values to predict AMI were 16.2 ng/L and 42.1% for the absolute and relative hs-cTnI changes, respectively. The area under the curve of hs-cTnI for AMI diagnosis was larger for absolute changes than for relative changes [0.96 (95% confidence interval [CI], 0.92–0.98) vs 0.89 (95% CI, 0.85–0.93)] (P = 0.014).
Conclusions
The absolute hs-cTnI change at 3 hours after presentation was superior to the relative change, and a rise and/or fall in hs-cTnI of > 16.2 ng/L at 3 hours after presentation was useful to identify AMI in patients presenting at the ED.

Keyword

Acute myocardial infarction; Chest pain; High-sensitivity cardiac troponin I; Emergency department; Absolute change

Figure

• 

  Fig. 1 Distribution of hs-cTnI values at presentation and 3 hours later in AMI and non-AMI groups. In each graph, the Y-axis is presented as a logarithmic scale. The central box represents the values from the lower to upper quartile (25th to 75th percentile). The middle line represents the median value. The vertical line extends from minimum to maximum values. Abbreviations: AMI, acute myocardial infarction; hs-cTnI, high-sensitivity cardiac troponin I.

• 

  Fig. 2 ROC curves for the hs-cTnI value at presentation, the hs-cTnI value at 3 hours after presentation, the absolute change in hs-cTnI, value and the relative change in hs-cTnI value for the diagnosis of AMI. Absolute change showed significant differences relative to the other values (vs hs-cTnI at presentation, P<0.001; vs hs-cTnI at 3 hours after presentation, P<0.001; vs relative change, P=0.003). Abbreviations: AMI, acute myocardial infarction; AUC, area under the curve; CI, confidence interval; hs-cTnI, high-sensitivity cardiac troponin I; ROC, receiver-operating characteristic. AUC (95% CI) P ROC cut-off Sensitivity (%, 95% CI) Specificity (%, 95% CI) hs-cTnI at presentation 0.76 (0.70–0.81) <0.001 87.1 ng/L 52.8 (40.7–64.7) 89.5 (84.5–93.3) hs-cTnI at 3 hours after presentation 0.92 (0.88–0.95) <0.001 48.7 ng/L 88.9 (79.3–95.1) 81.3 (75.4–86.4) Absolute change 0.96 (0.92–0.98) <0.001 16.2 ng/L 98.6 (92.5–99.8) 84.7 (79.1–89.3) Relative change 0.89 (0.85–0.93) <0.001 42.1% 81.9 (71.1–90.0) 80.9 (74.9–86.0)

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