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Sensitive troponin assay and the classification of myocardial infarction.

Shah AS, McAllister DA, Mills R, Lee KK, Churchhouse AM, Fleming KM, Layden E, Anand A, Fersia O, Joshi NV, Walker S, Jaffe AS, Fox KA, Newby DE, Mills NL - Am. J. Med. (2014)

Bottom Line: We assessed the impact of lowering the diagnostic threshold of troponin on the incidence, management, and outcome of patients with type 2 myocardial infarction or myocardial injury.In patients with troponin concentrations 50 to 199 ng/L, lowering the diagnostic threshold was associated with increased healthcare resource use (P < .05) that reduced recurrent myocardial infarction and death for patients with type 1 myocardial infarction (31% vs 20%; RR, 0.64; 95% CI, 0.41-0.99), but not type 2 myocardial infarction or myocardial injury (36% vs 33%; RR, 0.93; 95% CI, 0.75-1.15).Outcomes of patients with type 2 myocardial infarction or myocardial injury are poor and do not seem to be modifiable after reclassification despite substantial increases in healthcare resource use.

View Article: PubMed Central - PubMed

Affiliation: BHF Centre for Cardiovascular Science, Edinburgh University, Edinburgh, United Kingdom.

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Related in: MedlinePlus

Change in the investigation, management, and clinical outcomes of patients with type 1 myocardial infarction, type 2 myocardial infarction, and myocardial injury after implementation of a sensitive troponin assay. In patients with troponin concentrations of 50 to 199 ng/L and type 1 myocardial infarction, lowering the diagnostic threshold increased referrals for a specialist opinion, further investigation, and treatments for myocardial infarction (P < .01 for all). For patients with type 2 myocardial infarction and myocardial injury, similar patterns were seen, although the absolute magnitude was smaller. In patients with type 1 myocardial infarction, lowering the diagnostic threshold was associated with a significant reduction in recurrent myocardial infarction (absolute risk reduction, 12%; 95% CI, 3-23), whereas outcomes in patients with type 2 myocardial infarction and myocardial injury remained unchanged. DAPT = dual antiplatelet therapy; MI = myocardial infarction; PCI = percutaneous coronary intervention. *P < .05. ** P < .01. ***P < .001.
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fig3: Change in the investigation, management, and clinical outcomes of patients with type 1 myocardial infarction, type 2 myocardial infarction, and myocardial injury after implementation of a sensitive troponin assay. In patients with troponin concentrations of 50 to 199 ng/L and type 1 myocardial infarction, lowering the diagnostic threshold increased referrals for a specialist opinion, further investigation, and treatments for myocardial infarction (P < .01 for all). For patients with type 2 myocardial infarction and myocardial injury, similar patterns were seen, although the absolute magnitude was smaller. In patients with type 1 myocardial infarction, lowering the diagnostic threshold was associated with a significant reduction in recurrent myocardial infarction (absolute risk reduction, 12%; 95% CI, 3-23), whereas outcomes in patients with type 2 myocardial infarction and myocardial injury remained unchanged. DAPT = dual antiplatelet therapy; MI = myocardial infarction; PCI = percutaneous coronary intervention. *P < .05. ** P < .01. ***P < .001.

Mentions: Compared with patients with type 1 myocardial infarction, patients with type 2 myocardial infarction were more likely to die (16% vs 37%; relative risk [RR], 1.95; 95% CI, 1.61-2.37) but less likely to have recurrent myocardial infarction (12% vs 6%; RR, 0.46; 95% CI, 0.31-0.71) (Figure 3). Similar risk ratios were obtained for patients with myocardial injury with a higher proportion dead at 1 year (16% vs 37%; RR, 2.36; 95% CI, 1.99-2.81) and fewer recurrent myocardial infarcts (12% vs 4%; RR, 0.29; 95% CI, 0.18-0.46). Similar cause-specific hazards ratio were seen after adjusting for age and sex for both recurrent myocardial infarction and death (Figure 3).


Sensitive troponin assay and the classification of myocardial infarction.

Shah AS, McAllister DA, Mills R, Lee KK, Churchhouse AM, Fleming KM, Layden E, Anand A, Fersia O, Joshi NV, Walker S, Jaffe AS, Fox KA, Newby DE, Mills NL - Am. J. Med. (2014)

Change in the investigation, management, and clinical outcomes of patients with type 1 myocardial infarction, type 2 myocardial infarction, and myocardial injury after implementation of a sensitive troponin assay. In patients with troponin concentrations of 50 to 199 ng/L and type 1 myocardial infarction, lowering the diagnostic threshold increased referrals for a specialist opinion, further investigation, and treatments for myocardial infarction (P < .01 for all). For patients with type 2 myocardial infarction and myocardial injury, similar patterns were seen, although the absolute magnitude was smaller. In patients with type 1 myocardial infarction, lowering the diagnostic threshold was associated with a significant reduction in recurrent myocardial infarction (absolute risk reduction, 12%; 95% CI, 3-23), whereas outcomes in patients with type 2 myocardial infarction and myocardial injury remained unchanged. DAPT = dual antiplatelet therapy; MI = myocardial infarction; PCI = percutaneous coronary intervention. *P < .05. ** P < .01. ***P < .001.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4414368&req=5

fig3: Change in the investigation, management, and clinical outcomes of patients with type 1 myocardial infarction, type 2 myocardial infarction, and myocardial injury after implementation of a sensitive troponin assay. In patients with troponin concentrations of 50 to 199 ng/L and type 1 myocardial infarction, lowering the diagnostic threshold increased referrals for a specialist opinion, further investigation, and treatments for myocardial infarction (P < .01 for all). For patients with type 2 myocardial infarction and myocardial injury, similar patterns were seen, although the absolute magnitude was smaller. In patients with type 1 myocardial infarction, lowering the diagnostic threshold was associated with a significant reduction in recurrent myocardial infarction (absolute risk reduction, 12%; 95% CI, 3-23), whereas outcomes in patients with type 2 myocardial infarction and myocardial injury remained unchanged. DAPT = dual antiplatelet therapy; MI = myocardial infarction; PCI = percutaneous coronary intervention. *P < .05. ** P < .01. ***P < .001.
Mentions: Compared with patients with type 1 myocardial infarction, patients with type 2 myocardial infarction were more likely to die (16% vs 37%; relative risk [RR], 1.95; 95% CI, 1.61-2.37) but less likely to have recurrent myocardial infarction (12% vs 6%; RR, 0.46; 95% CI, 0.31-0.71) (Figure 3). Similar risk ratios were obtained for patients with myocardial injury with a higher proportion dead at 1 year (16% vs 37%; RR, 2.36; 95% CI, 1.99-2.81) and fewer recurrent myocardial infarcts (12% vs 4%; RR, 0.29; 95% CI, 0.18-0.46). Similar cause-specific hazards ratio were seen after adjusting for age and sex for both recurrent myocardial infarction and death (Figure 3).

Bottom Line: We assessed the impact of lowering the diagnostic threshold of troponin on the incidence, management, and outcome of patients with type 2 myocardial infarction or myocardial injury.In patients with troponin concentrations 50 to 199 ng/L, lowering the diagnostic threshold was associated with increased healthcare resource use (P < .05) that reduced recurrent myocardial infarction and death for patients with type 1 myocardial infarction (31% vs 20%; RR, 0.64; 95% CI, 0.41-0.99), but not type 2 myocardial infarction or myocardial injury (36% vs 33%; RR, 0.93; 95% CI, 0.75-1.15).Outcomes of patients with type 2 myocardial infarction or myocardial injury are poor and do not seem to be modifiable after reclassification despite substantial increases in healthcare resource use.

View Article: PubMed Central - PubMed

Affiliation: BHF Centre for Cardiovascular Science, Edinburgh University, Edinburgh, United Kingdom.

Show MeSH
Related in: MedlinePlus