Myocardial Infarction Risk Stratification With a Single Measurement of High-Sensitivity Troponin I

Y. Sandoval, Richard Nowak, Christopher R. deFilippi, Robert H. Christenson, W. Frank Peacock, J. McCord, Alexander T. Limkakeng, Anne Sexter, Fred S. Apple

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Background: Limited data exist on rapid risk-stratification strategies using the U.S. Food and Drug Administration–cleared high-sensitivity cardiac troponin I (hs-cTnI) assays. Objectives: This study sought to examine single measurement hs-cTnI to identify patients at low and high risk for acute myocardial infarction (MI). Methods: This was a prospective, multicenter, observational study of patients with suspected acute MI enrolled across 29 U.S. sites with hs-cTnI measured using the Atellica IM TnIH and ADVIA Centaur TNIH (Siemens Healthineers) assays. To identify low-risk patients, sensitivities and negative predictive values (NPVs) for acute MI and MI or death at 30 days were examined across baseline hs-cTnI concentrations. To identify high-risk patients, positive predictive values and specificities for acute MI were evaluated. Results: Among 2,212 patients, acute MI occurred in 12%. The limits of detection or quantitation resulted in excellent sensitivities (range 98.6% to 99.6%) and NPVs (range 99.5% to 99.8%) for acute MI or death at 30 days across both assays. An optimized threshold of <5 ng/l identified almost one-half of all patients as low risk, with sensitivities of 98.6% (95% confidence interval: 97.2% to 100%) and NPVs of 99.6% (95% confidence interval: 99.2% to 99.9%) for acute MI or death at 30 days across both assays. For high-risk patients, hs-cTnI ≥120 ng/l resulted in positive predictive values for acute MI of ≥70%. Conclusions: Recognizing the continuous relationship between baseline hs-cTnI and risk for adverse events, using 2 Food and Drug Administration–cleared hs-cTnI assays, an optimized threshold of <5 ng/l safely identified almost one-half of all patients as low risk at presentation, with hs-cTnI ≥120 ng/l identifying high-risk patients.

Original languageEnglish (US)
Pages (from-to)271-282
Number of pages12
JournalJournal of the American College of Cardiology
Volume74
Issue number3
DOIs
StatePublished - Jul 23 2019

Bibliographical note

Publisher Copyright:
© 2019 American College of Cardiology Foundation

Keywords

  • acute myocardial infarction
  • high-sensitivity cardiac troponin
  • risk stratification
  • troponin

PubMed: MeSH publication types

  • Journal Article
  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

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