scholarly journals Towards an improved definition of periprocedural myocardial infarction: The role of high‐sensitivity cardiac troponins

2021 ◽  
Author(s):  
Samuel Heuts ◽  
Iwan C. C. Horst ◽  
Alma Mingels
Keyword(s):  
Myocardial Infarction ◽  
High Sensitivity ◽  
Periprocedural Myocardial Infarction ◽  
Definition Of ◽  
Cardiac Troponins

scholarly journals Global Adoption of High-Sensitivity Cardiac Troponins and the Universal Definition of Myocardial Infarction

2019 ◽  
Vol 65 (3) ◽  
pp. 484-489 ◽  
Author(s):  
Atul Anand ◽  
Anoop S V Shah ◽  
Agim Beshiri ◽  
Allan S Jaffe ◽  
Nicholas L Mills
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Troponin ◽  
Clinical Pathways ◽  
High Sensitivity ◽  
Diagnosis And Management ◽  
Coronary Syndrome ◽  
Diagnostic Threshold ◽  
Serial Sampling ◽  
Universal Definition ◽  
Definition Of

Abstract BACKGROUND The universal definition of myocardial infarction (UDMI) standardizes the approach to the diagnosis and management of myocardial infarction. High-sensitivity cardiac troponin testing is recommended because these assays have improved precision at low concentrations, but concerns over specificity may have limited their implementation. METHODS We undertook a global survey of 1902 medical centers in 23 countries evenly distributed across 5 continents to assess adoption of key recommendations from the UDMI. Respondents involved in the diagnosis and management of patients with suspected acute coronary syndrome completed a structured telephone questionnaire detailing the primary biomarker, diagnostic thresholds, and clinical pathways used to identify myocardial infarction. RESULTS Cardiac troponin was the primary diagnostic biomarker at 96% of surveyed sites. Only 41% of centers had adopted high-sensitivity assays, with wide variation from 7% in North America to 60% in Europe. Sites using high-sensitivity troponin more frequently used serial sampling pathways (91% vs 78%) and the 99th percentile diagnostic threshold (74% vs 66%) than sites using previous-generation assays. Furthermore, high-sensitivity institutions more often used earlier serial sampling (≤3 h) and accelerated diagnostic pathways. Fewer than 1 in 5 high-sensitivity sites had adopted sex-specific thresholds (18%). CONCLUSIONS There has been global progress toward the recommendations of the UDMI, particularly in the use of the 99th percentile diagnostic threshold and serial sampling. However, high-sensitivity assays are still used by a minority of sites, and sex-specific thresholds by even fewer. Additional efforts are required to improve risk stratification and diagnosis of patients with myocardial infarction.

scholarly journals Discordance between ICD-Coded Myocardial Infarction and Diagnosis according to the Universal Definition of Myocardial Infarction

2017 ◽  
Vol 63 (1) ◽  
pp. 415-419 ◽  
Author(s):  
Jorge Díaz-Garzón ◽  
Yader Sandoval ◽  
Stephen W Smith ◽  
Sara Love ◽  
Karen Schulz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Troponin I ◽  
High Sensitivity ◽  
International Classification Of Diseases ◽  
Healthcare Management ◽  
Clinical Indication ◽  
Kappa Index ◽  
Universal Definition ◽  
Definition Of

Abstract BACKGROUND International Classification of Diseases (ICD) coding is the standard diagnostic tool for healthcare management. At present, type 2 myocardial infarction (T2MI) classification by the Universal Definition of Myocardial Infarction (MI) remains ignored in the ICD system. We determined the concordance for the diagnosis of MI using ICD-9 coding vs the Universal Definition. METHODS Cardiac troponin I (cTnI) was measured by both contemporary (cTnI) and high-sensitivity (hs-cTnI) assays in 1927 consecutive emergency department (ED) patients [Use of TROPonin In Acute coronary syndromes (UTROPIA) cohort] who had cTnI ordered on clinical indication. All patients were adjudicated using both contemporary and hs-cTnI assays. The Kappa index and McNemar test were used to assess concordance between ICD-9 code 410 and type 1 MI (T1MI) and type 2 MI (T2MI). RESULTS Among the 249 adjudicated MIs using the contemporary cTnI, only 69 (28%) were ICD-coded MIs. Of 180 patients not ICD coded as MI, 34 (19%) were T1MI and 146 (81%) were T2MI. For the ICD-coded MIs, 79% were T1MI and 21% were T2MI. A fair Kappa index, 0.386, and a McNemar difference of 0.0892 (P < 0.001) were found. Among the 207 adjudicated MIs using the hs-cTnI assay, 67 (32%) were ICD coded as MI. Of the 140 patients not ICD coded as MI, 27 (19%) were T1MI and 113 (81%) were T2MI. For the ICD-coded MIs, 85% were T1MI and 15% T2MI. A moderate Kappa index, 0.439, and a McNemar difference of 0.0674 (P < 0.001) were found. CONCLUSIONS ICD-9–coded MIs captured only a small proportion of adjudicated MIs, primarily from not coding T2MI. Our findings emphasize the need for an ICD code for T2MI.

Kinetics of high-sensitivity cardiac troponin T or troponin I compared to creatine kinase in patients with revascularized acute myocardial infarction

2015 ◽  
Vol 53 (5) ◽  
Author(s):  
Kamila Solecki ◽  
Anne Marie Dupuy ◽  
Nils Kuster ◽  
Florence Leclercq ◽  
Richard Gervasoni ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Troponin T ◽  
High Sensitivity ◽  
Cardiac Troponin T ◽  
Significant Difference ◽  
Kinetics Of

AbstractCardiac biomarkers are the cornerstone of the biological definition of acute myocardial infarction (AMI). The key role of troponins in diagnosis of AMI is well established. Moreover, kinetics of troponin I (cTnI) and creatine kinase (CK) after AMI are correlated to the prognosis. New technical assessment like high-sensitivity cardiac troponin T (hs-cTnT) raises concerns because of its unclear kinetic following the peak. This study aims to compare kinetics of cTnI and hs-cTnT to CK in patients with large AMI successfully treated by percutaneous coronary intervention (PCI).We prospectively studied 62 patients with anterior AMI successfully reperfused with primary angioplasty. We evaluated two consecutive groups: the first one regularly assessed by both CK and cTnI methods and the second group by CK and hs-cTnT. Modeling of kinetics was realized using mixed effects with cubic splines.Kinetics of markers showed a peak at 7.9 h for CK, at 10.9 h (6.9–12.75) for cTnI and at 12 h for hs-cTnT. This peak was followed by a nearly log linear decrease for cTnI and CK by contrast to hs-cTnT which appeared with a biphasic shape curve marked by a second peak at 82 h. There was no significant difference between the decrease of cTnI and CK (p=0.63). CK fell by 79.5% (76.1–99.9) vs. cTnI by 86.8% (76.6–92.7). In the hs-cTnT group there was a significant difference in the decrease by 26.5% (9–42.9) when compared with CK that fell by 79.5% (64.3–90.7).Kinetic of hs-cTnT and not cTnI differs from CK. The role of hs-cTnT in prognosis has to be investigated.

scholarly journals Cardiac troponins: current information on the main analytical characteristics of determination methods and new diagnostic possibilities

Medwave ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. e002132-e002132
Author(s):  
Aleksey M. Chaulin
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
Cross Reactivity ◽  
Current Data ◽  
Myocardial Infarctions ◽  
Low Sensitivity ◽  
Muscle Lesions ◽  
Cardiac Troponins

The methods used to diagnose cardiovascular diseases are constantly being improved, leading to an expanded perception of the diagnostic value of biomarkers and their new diagnostic possibilities. One striking example are the main biomarkers used to diagnose acute myocardial infarction: cardiac troponins. The first methods for determining cardiac troponins (proposed 30 years ago) were characterized by extremely low sensitivity. Therefore, they could only detect large acute myocardial infarctions. These methods were also characterized by low specificity, expressed as a high probability of cross-reactivity with skeletal troponin isoforms, which generated false-positive results in the presence of skeletal myopathies and skeletal muscle lesions. With the introduction of high-sensitivity cardiac troponins into clinical practice, the possibility of early diagnosis and exclusion of acute myocardial infarction by assessing troponin concentrations in the first few hours (from admission to the first hour, second hour, or third hour) has become more specific. Our knowledge about cardiac troponins has changed over the years and promising new medical uses have emerged. This paper reviews current data on the diagnostic value of cardiac troponins, the main methods used for their determination, and their analytical characteristics from historical and modern insights.

scholarly journals Global Adoption of High-Sensitivity Cardiac Troponins and the Universal Definition of Myocardial Infarction

2018 ◽  
Author(s):  
Atul Anand ◽  
Anoop SV Shah ◽  
Agim Beshiri ◽  
Allan S Jaffe ◽  
Nicholas L Mills
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Troponin ◽  
High Sensitivity ◽  
Diagnosis And Management ◽  
Coronary Syndrome ◽  
The Third ◽  
Diagnostic Threshold ◽  
Serial Sampling ◽  
Universal Definition ◽  
Definition Of

AbstractImportanceThe third Universal Definition of Myocardial Infarction aimed to standardize the approach to the diagnosis and management of myocardial infarction. High-sensitivity cardiac troponin testing was recommended, as these assays have improved precision at low concentrations, but concerns over specificity may have limited implementation.ObjectiveTo determine the global adoption of high-sensitivity cardiac troponin assays and key recommendations from the Universal Definition.Design, Setting and ParticipantsGlobal survey of 1,902 medical centers across 23 countries evenly distributed across all five continents. Included respondents were involved in the diagnosis and management of patients with suspected acute coronary syndrome at their institutions.Main Outcomes and MeasuresStructured questionnaire detailing the primary biomarker used for myocardial infarction, diagnostic thresholds and critical elements of clinical pathways for comparison to the third Universal Definition recommendations.ResultsCardiac troponin was the primary diagnostic biomarker for myocardial infarction at 96% of all sites surveyed. Only 41% of centers had adopted high-sensitivity cardiac troponin assays, with wide variation from 7% in North America to 60% in Europe. Sites using high-sensitivity assays more frequently employed serial sampling pathways (91% vs. 78%) and the 99th percentile diagnostic threshold (74% vs. 66%) when compared to sites using the previous generation of troponin assays. Furthermore, sites using high-sensitivity assays more often used earlier serial sampling (≤3 hours) and accelerated diagnostic pathways. However, fewer than 1 in 5 sites using high-sensitivity assays had adopted sex-specific thresholds (18%).Conclusions and RelevanceProgress has been made in adopting the recommendations of the Universal Definition of Myocardial Infarction, particularly in the use of the 99th percentile diagnostic threshold and serial sampling. However, high-sensitivity assays are used in a minority of sites and sex-specific thresholds in even fewer. These findings highlight regions where additional efforts are required to improve the risk stratification and diagnosis of patients with myocardial infarction.

MYOCARDIAL INFARCTION WITH NONOBSTRUCTIVE CORONARY ATHEROSCLEROSIS AS A CURRENT PROBLEM OF EMERGENCY CARDIOLOGY

2019 ◽  
Vol 33 (4) ◽  
pp. 10-18 ◽  
Author(s):  
V. V. Ryabov ◽  
S. B. Fedorova ◽  
E. V. Vyshlov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Atherosclerosis ◽  
Myocardial Injury ◽  
Current Problem ◽  
Diagnostic Algorithm ◽  
Future Research ◽  
Resonance Imaging ◽  
Definition Of ◽  
A Current

Myocardial infarction with nonobstructive coronary atherosclerosis is a term which emerged recently, but it is of great importance for current clinical practice. Under the mask of this diagnosis, not only ischemia-caused myocardial infarction is hiding, but also diseases with alternative mechanisms of myocardial injury. This review presents a definition of this term as well as differential diagnostic algorithm for diseases associated with increase in the myocardial injury markers. The role of magnetic resonance imaging is emphasized as it is the key method for diagnosis of cardiac diseases. Main principles of current recommendations in this regard are presented. Unsolved and undeveloped aspects of this problem are discussed. Directions for future research are outlined.

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