Sensitive troponin assay and the classification of myocardial infarction.
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.
Affiliation: BHF Centre for Cardiovascular Science, Edinburgh University, Edinburgh, United Kingdom.Show MeSH
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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).
Affiliation: BHF Centre for Cardiovascular Science, Edinburgh University, Edinburgh, United Kingdom.