01 Jun Heart Attack Can Be Ruled-Out in One Hour with High-Sensitivity Troponin I Assay
MedicalResearch.com Interview with:
Dr. med. Johannes Neumann
University Heart Center Hamburg
Department of General and Interventional Cardiology
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The early decision making in patients with suspected acute myocardial infarction is important. Current guidelines recommend measurement of cardiac troponin at admission and after 3 hours. In our study we evaluated the performance of a high-sensitivity troponin I assay with a rapid measurement after only 1 hour. We included 1040 patients with new onset chest pain and could show, that a low cutoff concentration of 6 ng/L after 1 hour allows safe rule-out of acute myocardial infarction. The results were comparable to the recommended 3-hour approach and were validated in 2 external cohorts. When using the 99th percentile to rule-out myocardial infarction, as recommended by current guidelines, the negative predictive value was much lower. Furthermore, a troponin I concentration above 6 ng/L in combination with an absolute change of 12 ng/L after 1 hour showed a high positive predictive value for the final diagnosis of myocardial infarction. This allows early decision making after only 1 hour.
MedicalResearch.com: What should readers take away from your report?
Response: The main message of our study is, that the use of a high-sensitivity troponin I assay requires application of lower cutoff concentrations, than the 99th percentile. This lower cutoff enables a fast management of patients with suspected AMI after only 1 hour.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: The results of our study are specific for this troponin I assay and need further validation using other troponin assays. Furthermore, a randomized trial is needed to test the non-inferiority of a rapid approach compared to the clinical standard of care.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Neumann J, Sörensen N, Schwemer T, et al. Diagnosis of Myocardial Infarction Using a High-Sensitivity Troponin I 1-Hour Algorithm.JAMA Cardiol. Published online June 01, 2016. doi:10.1001/jamacardio.2016.0695.
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