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Troponin I as a specific marker of myocardial injury: from theory to clinical practice in the diagnosis of acute coronary syndrome
- Source :
- Coronary artery disease. 15(8)
- Publication Year :
- 2004
-
Abstract
- Objective To assess the diagnostic accuracy of troponin I (TnI) elevation in patients with acute coronary syndrome (ACS) in the emergency department (ED). Methods We retrospectively studied 166 patients with elevated TnI and electrocardiographic (ECG) change consistent with non-ST-segment elevation myocardial infarction. They were transferred from the ED to our coronary care unit (CCU) to undergo coronary angiography. Results Significant coronary stenosis were identified in 101 (61%) of patients. The other 65 patients were found to have different cardiac diseases (n=52) and in 13 patients diagnoses were not even related to the cardiovascular system. Wall motion abnormalities were assessed by echocardiographic wall motion score index (WMSI). Positive predictive value (PPV) of TnI varied from 53 to 65% for higher progressive values of the biomarker. The following PPVs were then calculated: PPV(TnI+CK-MB)=64%; PPV(TnI+WMSI)=72%, PPV(TnI+CK-MB+WMSI)=74%. Conclusions Abnormal values of TnI were detected in a variety of diseases not related to ACS. Even if troponin release indicates myocardial injury, it is not always synonymous with infarction or ischemia. A misinterpretation of TnI elevation may give rise to a diagnostic dilemma and cause unnecessary morbidity. An integration of biomarkers (TnI and CK-MB), ECG and WMSI will help identify false-positive ACS patients and avoid inappropriate admissions to CCU.
- Subjects :
- Male
Acute coronary syndrome
medicine.medical_specialty
Ischemia
Myocardial Infarction
Infarction
Sensitivity and Specificity
Electrocardiography
Internal medicine
Troponin I
medicine
Humans
Myocardial infarction
Aged
biology
business.industry
General Medicine
Emergency department
Middle Aged
musculoskeletal system
medicine.disease
Prognosis
Troponin
ROC Curve
cardiovascular system
biology.protein
Cardiology
Coronary care unit
Female
Cardiology and Cardiovascular Medicine
business
Biomarkers
Subjects
Details
- ISSN :
- 09546928
- Volume :
- 15
- Issue :
- 8
- Database :
- OpenAIRE
- Journal :
- Coronary artery disease
- Accession number :
- edsair.doi.dedup.....317939ca76f54a369ddb536e3c82c160