Diagnosing myocardial infarction: a highly sensitive issue

Stefan Blankenberg,Johannes Tobias Neumann,Dirk Westermann

doi:10.1016/s0140-6736(18)31996-2

Stefan Blankenberg, Johannes Tobias Neumann + Show 1 more

Open Access

https://doi.org/10.1016/s0140-6736(18)31996-2

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Abstract

Diagnosing myocardial infarction: a highly sensitive issue

Highlights

The advent of high-sensitivity troponin assays to enable the quantification of troponin concentration in up to 95% of the general population is thought to improve clinical care in patients presenting with suspected infarction.[1,2]
The application of highsensitivity troponin assays could be beneficial by enabling the early ruling out of myocardial infarction on the basis of very low troponin concentrations;[3,4,5,6,7] precise and rapid diagnosis of myocardial infarction on the basis of troponin-based algorithms[8,9] followed by early treatment initiation; and improved risk stratification on the basis of low troponin concentrations that are only detectable by highsensitivity assays.[1]
Use of a high-sensitivity assay to diagnose those at risk did not significantly affect the risk of the combined endpoint of subsequent myocardial infarction or cardiovascular death

Summary

Introduction

The advent of high-sensitivity troponin assays to enable the quantification of troponin concentration in up to 95% of the general population is thought to improve clinical care in patients presenting with suspected infarction.[1,2] The application of highsensitivity troponin assays could be beneficial by enabling the early ruling out of myocardial infarction on the basis of very low troponin concentrations;[3,4,5,6,7] precise and rapid diagnosis of myocardial infarction on the basis of troponin-based algorithms[8,9] followed by early treatment initiation; and improved risk stratification on the basis of low troponin concentrations that are only detectable by highsensitivity assays.[1]. This design allows the comparison of outcomes 1 year after patient presentation at the emergency department, before and after implementation of this high-sensitivity assay across ten hospitals in Scotland. 1771 (17%) of these 10 360 patients were reclassified by the highsensitivity strategy, resulting in additional patients who had not been identified by the contemporary assay being identified by the high-sensitivity assay.

Results

Conclusion