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- W2148412628 abstract "<h3>Introduction</h3> The Universal Definition recommends the 99 percentile of cardiac troponin as the diagnostic threshold for myocardial infarction (MI) in patients with suspected acute coronary syndrome if the assay achieves a coefficient of variation (CV) <10%. However, due to imprecision in contemporary assays and concern of over diagnosing myocardial infarction, diagnostic thresholds are currently set at higher concentrations where the assay can achieve CV ≤10%. The aim of this study was to assess the relationship between plasma troponin I concentrations, assay precision and clinical outcomes in patients with suspected acute coronary syndrome. <h3>Methods</h3> Using a contemporary sensitive troponin I assay, consecutive patients admitted with suspected acute coronary syndrome (n=2092) were stratified according to the 99th percentile (0.012 ng/ml; CV 20.8%) and current diagnostic threshold (0.05 ng/ml; CV 7.2%) into three groups: <0.012 ng/ml, 0.012–0.049 ng/ml and ≥0.05 ng/ml. Event-free survival (recurrent myocardial infarction or death) at 1 year was compared between patients grouped by troponin I concentration. <h3>Results</h3> Plasma troponin concentrations were <0.012 ng/ml in 988 patients (47%), 0.012–0.049 ng/ml in 352 patients (17%) and ≥0.05 ng/ml in 752 patients (36%). At 1 year, patients with troponin concentrations 0.012–0.049 ng/ml were more likely to be dead or readmitted with recurrent myocardial infarction compared to those with troponin concentrations <0.012 ng/ml (13% vs 3%; OR 4.8, 95% CI 3.0 to 7.7; p<0.001). Compared to troponin ≥0.050 ng/ml, patients with troponin 0.012–0.049 ng/ml had a higher risk profile but were less likely to be diagnosed with, or investigated and treated for, acute coronary syndrome. <h3>Conclusions</h3> Lowering the diagnostic threshold to the 99th percentile and accepting greater assay imprecision would identify those at high-risk of recurrent MI and death, but increase the diagnosis of MI by 46%. It remains to be established whether reclassifying and treating these patients as MI would improve outcome." @default.
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- W2148412628 date "2012-05-01" @default.
- W2148412628 modified "2023-09-27" @default.
- W2148412628 title "128 Implications of lowering the threshold of cardiac troponin in the diagnosis of myocardial infarction" @default.
- W2148412628 doi "https://doi.org/10.1136/heartjnl-2012-301877b.128" @default.
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