No additional value of conventional and high-sensitivity cardiac
                    troponin over clinical scoring systems in the differential diagnosis of type 1
                    vs. type 2 myocardial infarction

Luciano Consuegra-Sánchez; Juan José Martínez-Díaz; Luis García de Guadiana-Romualdo; Samantha Wasniewski; Patricia Esteban-Torrella; Francisco Guillermo Clavel-Ruipérez; Alfredo Bardají; Juan Antonio Castillo-Moreno; Juan Carlos Kaski

doi:10.1515/cclm-2017-0609

Article

No additional value of conventional and high-sensitivity cardiac troponin over clinical scoring systems in the differential diagnosis of type 1 vs. type 2 myocardial infarction

Luciano Consuegra-Sánchez , Juan José Martínez-Díaz , Luis García de Guadiana-Romualdo , Samantha Wasniewski , Patricia Esteban-Torrella , Francisco Guillermo Clavel-Ruipérez , Alfredo Bardají , Juan Antonio Castillo-Moreno and Juan Carlos Kaski

Published/Copyright: January 5, 2018

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From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 56 Issue 5

Abstract

Background:

The distinction of type 1 and type 2 myocardial infarction (MI) is of major clinical importance. Our aim was to evaluate the diagnostic ability of absolute and relative conventional cardiac troponin I (cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) in the distinction between type 1 and type 2 MI in patients presenting at the emergency department with non-ST-segment elevation acute chest pain within the first 12 h.

Methods:

We measured cTnI (Dimension Vista) and hs-cTnT (Cobas e601) concentrations at presentation and after 4 h in 200 patients presenting with suspected acute MI. The final diagnosis, based on standard criteria, was adjudicated by two independent cardiologists.

Results:

One hundred and twenty-five patients (62.5%)were classified as type 1 MI and 75 (37.5%) were type 2 MI. In a multivariable setting, age (relative risk [RR]=1.43, p=0.040), male gender (RR=2.22, p=0.040), T-wave inversion (RR=8.51, p<0.001), ST-segment depression (RR=8.71, p<0.001) and absolute delta hs-cTnT (RR=2.10, p=0.022) were independently associated with type 1 MI. In a receiver operating characteristic curve analysis, the discriminatory power of absolute delta cTnI and hs-cTnT was significantly higher compared to relative c-TnI and hs-cTnT changes. The additive information provided by cTnI and hs-cTnT over and above the information provided by the “clinical” model was only marginal.

Conclusions:

The diagnostic information provided by serial measurements of conventional or hs-cTnT is not better than that yielded by a simple clinical scoring model. Absolute changes are more informative than relative troponin changes.

Keywords: cardiac troponin; clinical scores; differential diagnosis; myocardial infarction

aLuciano Consuegra-Sánchez and Juan José Martínez-Díaz contributed equally to this work.

Corresponding author: Luciano Consuegra-Sánchez, MD, PhD, Servicio de Cardiología, Hospital General Universitario de Santa Lucía, Universidad Católica San Antonio de Murcia (UCAM), Paraje los Arcos, S/N, 30201, Cartagena, Murcia, Spain, Phone: +34 658659063

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2017-7-12

Accepted: 2017-12-5

Published Online: 2018-1-5

Published in Print: 2018-4-25

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Articles in the same Issue

https://doi.org/10.1515/cclm-2017-0609

Keywords for this article

cardiac troponin; clinical scores; differential diagnosis; myocardial infarction