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February 1, 2004Clinical ChemistryOpen Access

Rates of Positive Cardiac Troponin I and Creatine Kinase MB Mass among Patients Hospitalized for Suspected Acute Coronary Syndromes

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Why the study?

Does the use of ESC/ACC recommended 99th percentile reference cutoffs for cTnI and CKMB increase the rates of diagnosis of acute myocardial infarction in patients with suspected ACS compared to ROC curve-derived cutoffs?

Population

1719 consecutive adult patients hospitalized with suspected acute coronary syndrome at an urban acute care…

Comparison

Application of lower reference cutoffs for… vs Application of higher reference cutoffs

Design

Cohort

Authors

JLJoseph LinFAFred S. AppleMMMaryAnn M. Murakami

Discussion

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Overview

May increase AMI diagnoses with 99th percentile cutoffs; leaves open whether this improves outcomes or warrants threshold adjustment.

Structured PICO

Does the use of ESC/ACC recommended 99th percentile reference cutoffs for cTnI and CKMB increase the rates of diagnosis of acute myocardial infarction in patients with suspected ACS compared to ROC curve-derived cutoffs?

P
Population
1719 consecutive adult patients (≥18 years of age) hospitalized with suspected acute coronary syndrome (ACS) at an urban acute care hospital over a 6-month period.
I
Intervention
Application of lower reference cutoffs for plasma biomarkers (ESC/ACC recommended 99th percentile cutoff: cTnI <0.1 microg/L, CKMB <3.9 microg/L)
C
Comparator
Application of higher reference cutoffs (ROC curve derived: cTnI ≤1.2 microg/L, CKMB ≤10.0 microg/L)
O
Outcome
Prevalence of positive cTnI and CKMB cases (rates of diagnosis of acute myocardial infarction)surrogate

Using the ESC/ACC recommended 99th percentile cutoffs for cardiac biomarkers markedly increases the diagnosis rate of acute myocardial infarction compared to traditional ROC-derived cutoffs.

Cite This Study

Lin et al. (2004) studied this question.

synapsesocial.com/papers/6a7cab2d263fc0f117fab63chttps://doi.org/10.1373/clinchem.2003.026708
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Improved detection of minor ischemic myocardial injury with measurement of serum cardiac troponin I1997 · 192 citations
  2. 2Plasma 99th Percentile Reference Limits for Cardiac Troponin and Creatine Kinase MB Mass for Use with European Society of Cardiology/American College of Cardiology Consensus Recommendations2003 · 327 citations
  3. 3Myocardial infarction redefined: the new ACC/ESC definition, based on cardiac troponin, increases the apparent incidence of infarction2002 · 125 citations
  4. 4The New Definition of Myocardial Infarction2002 · 105 citations
  5. 5It’s Time for a Change to a Troponin Standard2000 · 656 citations