Cardiac troponin changes to distinguish type 1 and type 2 myocardial infarction and 180-day mortality risk

Yader Sandoval, Sarah E. Thordsen, Stephen W. Smith, Karen M. Schulz, maryann M. Murakami, Lesly A. Pearce, Fred S. Apple

Research output: Contribution to journalArticlepeer-review

53 Scopus citations

Abstract

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. 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 cTnImax0–6h > 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 cTnImax 0–6h ≤ 34 ng/l. 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.

Original languageEnglish (US)
Pages (from-to)317-325
Number of pages9
JournalEuropean Heart Journal: Acute Cardiovascular Care
Volume3
Issue number4
DOIs
StatePublished - Dec 2014

Keywords

  • Myocardial infarction
  • cardiac troponin
  • delta troponin
  • risk outcomes
  • type 2 MI
  • universal definition

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