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    Application of High Sensitivity Troponin in Suspected Myocardial Infraction

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    michal ben meron
    This study evaluated the use of high-sensitivity troponin (hs-Tn) to rule out myocardial infarction (MI) in over 22,000 patients presenting with chest pain. Patients were stratified into low or high risk categories based on hs-Tn concentrations and changes over time. Patients in the low risk category had a very low chance of MI and could potentially be discharged earlier. Those in the high risk group had higher hs-Tn levels and changes indicating a higher risk of MI and need for more aggressive treatment. Follow up also found patients without MI but elevated hs-Tn still had double the long-term risk of death or MI compared to the general population.

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    Application of High Sensitivity Troponin in Suspected Myocardial Infraction

    Uploaded by

    michal ben meron
    24 views23 pages
    This study evaluated the use of high-sensitivity troponin (hs-Tn) to rule out myocardial infarction (MI) in over 22,000 patients presenting with chest pain. Patients were stratified into low or high risk categories based on hs-Tn concentrations and changes over time. Patients in the low risk category had a very low chance of MI and could potentially be discharged earlier. Those in the high risk group had higher hs-Tn levels and changes indicating a higher risk of MI and need for more aggressive treatment. Follow up also found patients without MI but elevated hs-Tn still had double the long-term risk of death or MI compared to the general population.

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    This study evaluated the use of high-sensitivity troponin (hs-Tn) to rule out myocardial infarction (MI) in over 22,000 patients presenting with chest pain. Patients were stratified into low or high risk categories based on hs-Tn concentrations and changes over time. Patients in the low risk category had a very low chance of MI and could potentially be discharged earlier. Those in the high risk group had higher hs-Tn levels and changes indicating a higher risk of MI and need for more aggressive treatment. Follow up also found patients without MI but elevated hs-Tn still had double the long-term risk of death or MI compared to the general population.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    24 views23 pages

    Application of High Sensitivity Troponin in Suspected Myocardial Infraction

    Uploaded by

    michal ben meron
    This study evaluated the use of high-sensitivity troponin (hs-Tn) to rule out myocardial infarction (MI) in over 22,000 patients presenting with chest pain. Patients were stratified into low or high risk categories based on hs-Tn concentrations and changes over time. Patients in the low risk category had a very low chance of MI and could potentially be discharged earlier. Those in the high risk group had higher hs-Tn levels and changes indicating a higher risk of MI and need for more aggressive treatment. Follow up also found patients without MI but elevated hs-Tn still had double the long-term risk of death or MI compared to the general population.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 23

    APPLICATION OF HIGH

    SENSITIVITY TROPONIN IN
    SUSPECTED MYOCARDIAL
    INFRACTION
    Liron Naftali Ben Haim
    Troponin
    ■ Crossbridge
    ■ Subuits: TnT, TnC, TnI
    BIOMARKER
    S
    Study Questions

    ■ How can high-sensitivity troponin (hs-Tn) concentrations, its change during serial
    sampling, and the time between sample be incorporated as a strategy to rule out
    myocardial infarction (MI) in patients presenting to the emergency department with
    chest pain?
    ■ The prognosis of patients with persistently elevated troponin who do not have MI
    remains unclear.
    Methods- acute study population

    ■ 15 studies, 13 countries, three geographic regions.


    ■ Inclusion criteria.
    ■ Exclusion criteria.
    Methods -acute study population

    ■ Troponin measurements
    ■ Serial resampling:
    – Early resampling (>45 to 120 minutes)
    – Late resampling (>120 to 210 minutes)
    Methods- follow up

    ■ All patients were followed up for at least one month.


    ■ Short term end points.
    Results- suspected MI

    ■ 23,327 patients.
    ■ 676 patients were excluded- STEMI
    ■ 22,651 patients
    ■ 9,604 patients- derivation data set; 13,047 validation data set.
    ■ Final diagnosis of MI in 3,455 patients (15.3%)
    Results
    Results
    Results- Low risk

    ■ Very low concentrations of troponin T and I at presentation


    ■ Small absolute changes on serial sampling.
    ■ High negative predictive value.
    ■ Low risk for MI/ death from any cause at 30 days.
    Results- Low risk
    Results- High risk

    ■ Higher concentrations of troponin T and I at presentation


    ■ larger absolute changes on serial sampling.
    ■ High positive predictive value.
    ■ higher risk for MI/ death from any cause at 30 days.
    Results- High risk
    Results

    ■ http://compass-mi.com/
    ■ Allows classification of patients into low risk and high risk categories.
    Methods- long term risk assessments

    ■ Comparison of:
    – Patients in the acute study population who did not have MI
    – Persons in the general population
    11 cohorts, 8 countries
    Only troponin I was measured in the general population.
    ■ Detailed matching
    ■ End point- the incidence of MI or death from any cause in general population at 1 and 2
    years.
    Results- acute population without MI
    ■ 7,682 matched pairs.
    Results- acute population without MI

    Acute study population


    ■ Median follow up time- 730 days.
    ■ 271 patients (3.9%) had reached the end point of death/MI after 1 year.
    ■ 398 patients (6.3%) had reached the end point of death/MI after 2 years.
    General population
    ■ Median follow up time- 8 years.
    ■ 80 persons (1%) had reached the end point of death/MI after 1 year.
    ■ 198 patients (2.6%) had reached the end point of death/MI after 2 years.
    Results
    ■ In both, the acute study population and the population based cohort, troponin
    concentrations were strongly associated with MI/death after 1 and 2 years.
    Discussion

    ■ The approach presented here provides risk probabilities for MI using a wide range of
    cutoff combinations of troponin concentrations.
    ■ Assignment of patients to the low risk category may allow discharge after other life-
    threatening causes of chest pain have been ruled out.
    ■ Patients assigned to the high risk category are candidates for early invasive strategies.
    ■ Patients with persistently high but nondynamic concentrations of troponin without MI-
    troponin is a risk prediction biomarker.
    Limitations

    ■ The diagnosis of MI was based on adjudication within each cohort.


    ■ Study populations had different pretest probabilities of MI.
    ■ Samples of Troponin I concentrations that were determined in the general population
    had been stored for up to two decades.

    ■ Acute study population of the matching


    Clinical use?
    THANK
    YOU!

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