Implementation of a Sensitive Troponin I Assay and Risk of Recurrent Myocardial Infarction and Death in Patients With Suspected Acute Coronary Syndrome

CONTEXT Although troponin assays have become increasingly more sensitive, it is unclear whether further reductions in the threshold of detection for plasma troponin concentrations will improve clinical outcomes in patients with suspected acute coronary syndrome (ACS). OBJECTIVE To determine whether...

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Published in:JAMA : the journal of the American Medical Association 2011-03, Vol.305 (12), p.1210-1216
Main Authors: Mills, Nicholas L, Churchhouse, Antonia M. D, Lee, Kuan Ken, Anand, Atul, Gamble, David, Shah, Anoop S. V, Paterson, Elspeth, MacLeod, Margaret, Graham, Catriona, Walker, Simon, Denvir, Martin A, Fox, Keith A. A, Newby, David E
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - complications
Acute Coronary Syndrome - diagnosis
Acute coronary syndromes
Aged
Aged, 80 and over
Assays
Biological and medical sciences
Cardiology. Vascular system
Coronary heart disease
Female
General aspects
Heart
Heart attacks
Humans
Kaplan-Meier Estimate
Male
Medical sciences
Middle Aged
Morbidity
Mortality
myocardial infarction
Myocardial Infarction - blood
Myocardial Infarction - diagnosis
Myocardial Infarction - etiology
Myocardial Infarction - mortality
Myocarditis. Cardiomyopathies
Outcome Assessment (Health Care)
Prognosis
Prospective Studies
Reference Values
Risk Assessment
Sensitivity and Specificity
survival
Troponin I - blood
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Summary:CONTEXT Although troponin assays have become increasingly more sensitive, it is unclear whether further reductions in the threshold of detection for plasma troponin concentrations will improve clinical outcomes in patients with suspected acute coronary syndrome (ACS). OBJECTIVE To determine whether lowering the diagnostic threshold for myocardial infarction (MI) with a sensitive troponin assay could improve clinical outcomes. DESIGN, SETTING, AND PATIENTS All consecutive patients admitted with suspected ACS to the Royal Infirmary of Edinburgh, Edinburgh, Scotland, before (n = 1038; February 1-July 31, 2008, during the validation phase) and after (n = 1054; February 1-July 31, 2009, during the implementation phase) lowering the threshold of detection for myocardial necrosis from 0.20 to 0.05 ng/mL with a sensitive troponin I assay were stratified into 3 groups (
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.2011.338