Application of High-Sensitivity Troponin in Suspected Myocardial Infarction

Johannes T. Neumann, Raphael Twerenbold, Francisco Ojeda, Nils A. Sörensen, Andrew R. Chapman, Anoop S. V. Shah, Atul Anand, Jasper Boeddinghaus, Thomas Nestelberger, Patrick Badertscher, Arash Mokhtari, John W. Pickering, Richard W. Troughton, Jaimi Greenslade, William Parsonage, Matthias Mueller-Hennessen, Tommaso Gori, Tomas Jernberg, Niall Morris, Christoph LiebetrauChristian Hamm, Hugo A. Katus, Thomas Münzel, Ulf Landmesser, Veikko Salomaa, Licia Iacoviello, Marco M. Ferrario, Simona Giampaoli, Frank Kee, Barbara Thorand, Annette Peters, Rossana Borchini, Torben Jørgensen, Stefan Söderberg, Susana Sans, Hugh Tunstall-Pedoe, Kari Kuulasmaa, Thomas Renné, Karl J. Lackner, Andrew Worster, Richard Body, Ulf Ekelund, Peter A. Kavsak, Till Keller, Bertil Lindahl, Philipp Wild, Evangelos Giannitsis, Martin Than, Louise A. Cullen, Nicholas L. Mills, Christian Mueller, Tanja Zeller, Dirk Westermann, Stefan Blankenberg

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Data regarding high-sensitivity troponin concentrations in patients presenting to the emergency department with symptoms suggestive of myocardial infarction may be useful in determining the probability of myocardial infarction and subsequent 30-day outcomes.

Methods: In 15 international cohorts of patients presenting to the emergency department with symptoms suggestive of myocardial infarction, we determined the concentrations of high-sensitivity troponin I or high-sensitivity troponin T at presentation and after early or late serial sampling. The diagnostic and prognostic performance of multiple high-sensitivity troponin cutoff combinations was assessed with the use of a derivation–validation design. A risk-assessment tool that was based on these data was developed to estimate the risk of index myocardial infarction and of subsequent myocardial infarction or death at 30 days.

Results: Among 22,651 patients (9604 in the derivation data set and 13,047 in the validation data set), the prevalence of myocardial infarction was 15.3%. Lower high-sensitivity troponin concentrations at presentation and smaller absolute changes during serial sampling were associated with a lower likelihood of myocardial infarction and a lower short-term risk of cardiovascular events. For example, high-sensitivity troponin I concentrations of less than 6 ng per liter and an absolute change of less than 4 ng per liter after 45 to 120 minutes (early serial sampling) resulted in a negative predictive value of 99.5% for myocardial infarction, with an associated 30-day risk of subsequent myocardial infarction or death of 0.2%; a total of 56.5% of the patients would be classified as being at low risk. These findings were confirmed in an external validation data set.

Conclusions: A risk-assessment tool, which we developed to integrate the high-sensitivity troponin I or troponin T concentration at emergency department presentation, its dynamic change during serial sampling, and the time between the obtaining of samples, was used to estimate the probability of myocardial infarction on emergency department presentation and 30-day outcomes.
Original languageEnglish
Pages (from-to)2529-2540
Number of pages12
JournalNew England Journal of Medicine
Volume380
Issue number26
DOIs
Publication statusPublished - 27 Jun 2019

Fingerprint

Troponin
Myocardial Infarction
Troponin I
Hospital Emergency Service
Troponin T

Keywords

  • Adult
  • Aged
  • Biomarkers/blood
  • Cohort Studies
  • Emergency Service, Hospital
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction/blood
  • Prognosis
  • Risk Assessment/methods
  • Sensitivity and Specificity
  • Troponin I/blood
  • Troponin/blood

Cite this

Neumann, J. T., Twerenbold, R., Ojeda, F., Sörensen, N. A., Chapman, A. R., Shah, A. S. V., ... Blankenberg, S. (2019). Application of High-Sensitivity Troponin in Suspected Myocardial Infarction. New England Journal of Medicine, 380(26), 2529-2540. https://doi.org/10.1056/NEJMoa1803377
Neumann, Johannes T. ; Twerenbold, Raphael ; Ojeda, Francisco ; Sörensen, Nils A. ; Chapman, Andrew R. ; Shah, Anoop S. V. ; Anand, Atul ; Boeddinghaus, Jasper ; Nestelberger, Thomas ; Badertscher, Patrick ; Mokhtari, Arash ; Pickering, John W. ; Troughton, Richard W. ; Greenslade, Jaimi ; Parsonage, William ; Mueller-Hennessen, Matthias ; Gori, Tommaso ; Jernberg, Tomas ; Morris, Niall ; Liebetrau, Christoph ; Hamm, Christian ; Katus, Hugo A. ; Münzel, Thomas ; Landmesser, Ulf ; Salomaa, Veikko ; Iacoviello, Licia ; Ferrario, Marco M. ; Giampaoli, Simona ; Kee, Frank ; Thorand, Barbara ; Peters, Annette ; Borchini, Rossana ; Jørgensen, Torben ; Söderberg, Stefan ; Sans, Susana ; Tunstall-Pedoe, Hugh ; Kuulasmaa, Kari ; Renné, Thomas ; Lackner, Karl J. ; Worster, Andrew ; Body, Richard ; Ekelund, Ulf ; Kavsak, Peter A. ; Keller, Till ; Lindahl, Bertil ; Wild, Philipp ; Giannitsis, Evangelos ; Than, Martin ; Cullen, Louise A. ; Mills, Nicholas L. ; Mueller, Christian ; Zeller, Tanja ; Westermann, Dirk ; Blankenberg, Stefan. / Application of High-Sensitivity Troponin in Suspected Myocardial Infarction. In: New England Journal of Medicine. 2019 ; Vol. 380, No. 26. pp. 2529-2540.
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title = "Application of High-Sensitivity Troponin in Suspected Myocardial Infarction",
abstract = "Background: Data regarding high-sensitivity troponin concentrations in patients presenting to the emergency department with symptoms suggestive of myocardial infarction may be useful in determining the probability of myocardial infarction and subsequent 30-day outcomes.Methods: In 15 international cohorts of patients presenting to the emergency department with symptoms suggestive of myocardial infarction, we determined the concentrations of high-sensitivity troponin I or high-sensitivity troponin T at presentation and after early or late serial sampling. The diagnostic and prognostic performance of multiple high-sensitivity troponin cutoff combinations was assessed with the use of a derivation–validation design. A risk-assessment tool that was based on these data was developed to estimate the risk of index myocardial infarction and of subsequent myocardial infarction or death at 30 days.Results: Among 22,651 patients (9604 in the derivation data set and 13,047 in the validation data set), the prevalence of myocardial infarction was 15.3{\%}. Lower high-sensitivity troponin concentrations at presentation and smaller absolute changes during serial sampling were associated with a lower likelihood of myocardial infarction and a lower short-term risk of cardiovascular events. For example, high-sensitivity troponin I concentrations of less than 6 ng per liter and an absolute change of less than 4 ng per liter after 45 to 120 minutes (early serial sampling) resulted in a negative predictive value of 99.5{\%} for myocardial infarction, with an associated 30-day risk of subsequent myocardial infarction or death of 0.2{\%}; a total of 56.5{\%} of the patients would be classified as being at low risk. These findings were confirmed in an external validation data set.Conclusions: A risk-assessment tool, which we developed to integrate the high-sensitivity troponin I or troponin T concentration at emergency department presentation, its dynamic change during serial sampling, and the time between the obtaining of samples, was used to estimate the probability of myocardial infarction on emergency department presentation and 30-day outcomes.",
keywords = "Adult, Aged, Biomarkers/blood, Cohort Studies, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Myocardial Infarction/blood, Prognosis, Risk Assessment/methods, Sensitivity and Specificity, Troponin I/blood, Troponin/blood",
author = "Neumann, {Johannes T.} and Raphael Twerenbold and Francisco Ojeda and S{\"o}rensen, {Nils A.} and Chapman, {Andrew R.} and Shah, {Anoop S. V.} and Atul Anand and Jasper Boeddinghaus and Thomas Nestelberger and Patrick Badertscher and Arash Mokhtari and Pickering, {John W.} and Troughton, {Richard W.} and Jaimi Greenslade and William Parsonage and Matthias Mueller-Hennessen and Tommaso Gori and Tomas Jernberg and Niall Morris and Christoph Liebetrau and Christian Hamm and Katus, {Hugo A.} and Thomas M{\"u}nzel and Ulf Landmesser and Veikko Salomaa and Licia Iacoviello and Ferrario, {Marco M.} and Simona Giampaoli and Frank Kee and Barbara Thorand and Annette Peters and Rossana Borchini and Torben J{\o}rgensen and Stefan S{\"o}derberg and Susana Sans and Hugh Tunstall-Pedoe and Kari Kuulasmaa and Thomas Renn{\'e} and Lackner, {Karl J.} and Andrew Worster and Richard Body and Ulf Ekelund and Kavsak, {Peter A.} and Till Keller and Bertil Lindahl and Philipp Wild and Evangelos Giannitsis and Martin Than and Cullen, {Louise A.} and Mills, {Nicholas L.} and Christian Mueller and Tanja Zeller and Dirk Westermann and Stefan Blankenberg",
note = "(Funded by the German Center for Cardiovascular Research [DZHK]; ClinicalTrials.gov numbers, NCT00470587, NCT02355457, NCT01852123, NCT01994577, and NCT03227159; and Australian New Zealand Clinical Trials Registry numbers, ACTRN12611001069943, ACTRN12610000766011, ACTRN12613000745741, and ACTRN12611000206921.)",
year = "2019",
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journal = "New England Journal of Medicine",
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Neumann, JT, Twerenbold, R, Ojeda, F, Sörensen, NA, Chapman, AR, Shah, ASV, Anand, A, Boeddinghaus, J, Nestelberger, T, Badertscher, P, Mokhtari, A, Pickering, JW, Troughton, RW, Greenslade, J, Parsonage, W, Mueller-Hennessen, M, Gori, T, Jernberg, T, Morris, N, Liebetrau, C, Hamm, C, Katus, HA, Münzel, T, Landmesser, U, Salomaa, V, Iacoviello, L, Ferrario, MM, Giampaoli, S, Kee, F, Thorand, B, Peters, A, Borchini, R, Jørgensen, T, Söderberg, S, Sans, S, Tunstall-Pedoe, H, Kuulasmaa, K, Renné, T, Lackner, KJ, Worster, A, Body, R, Ekelund, U, Kavsak, PA, Keller, T, Lindahl, B, Wild, P, Giannitsis, E, Than, M, Cullen, LA, Mills, NL, Mueller, C, Zeller, T, Westermann, D & Blankenberg, S 2019, 'Application of High-Sensitivity Troponin in Suspected Myocardial Infarction', New England Journal of Medicine, vol. 380, no. 26, pp. 2529-2540. https://doi.org/10.1056/NEJMoa1803377

Application of High-Sensitivity Troponin in Suspected Myocardial Infarction. / Neumann, Johannes T.; Twerenbold, Raphael; Ojeda, Francisco; Sörensen, Nils A.; Chapman, Andrew R.; Shah, Anoop S. V.; Anand, Atul; Boeddinghaus, Jasper; Nestelberger, Thomas; Badertscher, Patrick; Mokhtari, Arash; Pickering, John W.; Troughton, Richard W.; Greenslade, Jaimi; Parsonage, William; Mueller-Hennessen, Matthias; Gori, Tommaso; Jernberg, Tomas; Morris, Niall; Liebetrau, Christoph; Hamm, Christian; Katus, Hugo A.; Münzel, Thomas; Landmesser, Ulf; Salomaa, Veikko; Iacoviello, Licia; Ferrario, Marco M.; Giampaoli, Simona; Kee, Frank; Thorand, Barbara; Peters, Annette; Borchini, Rossana; Jørgensen, Torben; Söderberg, Stefan; Sans, Susana; Tunstall-Pedoe, Hugh; Kuulasmaa, Kari; Renné, Thomas; Lackner, Karl J.; Worster, Andrew; Body, Richard; Ekelund, Ulf; Kavsak, Peter A.; Keller, Till; Lindahl, Bertil; Wild, Philipp; Giannitsis, Evangelos; Than, Martin; Cullen, Louise A.; Mills, Nicholas L.; Mueller, Christian; Zeller, Tanja; Westermann, Dirk; Blankenberg, Stefan (Lead / Corresponding author).

In: New England Journal of Medicine, Vol. 380, No. 26, 27.06.2019, p. 2529-2540.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Application of High-Sensitivity Troponin in Suspected Myocardial Infarction

AU - Neumann, Johannes T.

AU - Twerenbold, Raphael

AU - Ojeda, Francisco

AU - Sörensen, Nils A.

AU - Chapman, Andrew R.

AU - Shah, Anoop S. V.

AU - Anand, Atul

AU - Boeddinghaus, Jasper

AU - Nestelberger, Thomas

AU - Badertscher, Patrick

AU - Mokhtari, Arash

AU - Pickering, John W.

AU - Troughton, Richard W.

AU - Greenslade, Jaimi

AU - Parsonage, William

AU - Mueller-Hennessen, Matthias

AU - Gori, Tommaso

AU - Jernberg, Tomas

AU - Morris, Niall

AU - Liebetrau, Christoph

AU - Hamm, Christian

AU - Katus, Hugo A.

AU - Münzel, Thomas

AU - Landmesser, Ulf

AU - Salomaa, Veikko

AU - Iacoviello, Licia

AU - Ferrario, Marco M.

AU - Giampaoli, Simona

AU - Kee, Frank

AU - Thorand, Barbara

AU - Peters, Annette

AU - Borchini, Rossana

AU - Jørgensen, Torben

AU - Söderberg, Stefan

AU - Sans, Susana

AU - Tunstall-Pedoe, Hugh

AU - Kuulasmaa, Kari

AU - Renné, Thomas

AU - Lackner, Karl J.

AU - Worster, Andrew

AU - Body, Richard

AU - Ekelund, Ulf

AU - Kavsak, Peter A.

AU - Keller, Till

AU - Lindahl, Bertil

AU - Wild, Philipp

AU - Giannitsis, Evangelos

AU - Than, Martin

AU - Cullen, Louise A.

AU - Mills, Nicholas L.

AU - Mueller, Christian

AU - Zeller, Tanja

AU - Westermann, Dirk

AU - Blankenberg, Stefan

N1 - (Funded by the German Center for Cardiovascular Research [DZHK]; ClinicalTrials.gov numbers, NCT00470587, NCT02355457, NCT01852123, NCT01994577, and NCT03227159; and Australian New Zealand Clinical Trials Registry numbers, ACTRN12611001069943, ACTRN12610000766011, ACTRN12613000745741, and ACTRN12611000206921.)

PY - 2019/6/27

Y1 - 2019/6/27

N2 - Background: Data regarding high-sensitivity troponin concentrations in patients presenting to the emergency department with symptoms suggestive of myocardial infarction may be useful in determining the probability of myocardial infarction and subsequent 30-day outcomes.Methods: In 15 international cohorts of patients presenting to the emergency department with symptoms suggestive of myocardial infarction, we determined the concentrations of high-sensitivity troponin I or high-sensitivity troponin T at presentation and after early or late serial sampling. The diagnostic and prognostic performance of multiple high-sensitivity troponin cutoff combinations was assessed with the use of a derivation–validation design. A risk-assessment tool that was based on these data was developed to estimate the risk of index myocardial infarction and of subsequent myocardial infarction or death at 30 days.Results: Among 22,651 patients (9604 in the derivation data set and 13,047 in the validation data set), the prevalence of myocardial infarction was 15.3%. Lower high-sensitivity troponin concentrations at presentation and smaller absolute changes during serial sampling were associated with a lower likelihood of myocardial infarction and a lower short-term risk of cardiovascular events. For example, high-sensitivity troponin I concentrations of less than 6 ng per liter and an absolute change of less than 4 ng per liter after 45 to 120 minutes (early serial sampling) resulted in a negative predictive value of 99.5% for myocardial infarction, with an associated 30-day risk of subsequent myocardial infarction or death of 0.2%; a total of 56.5% of the patients would be classified as being at low risk. These findings were confirmed in an external validation data set.Conclusions: A risk-assessment tool, which we developed to integrate the high-sensitivity troponin I or troponin T concentration at emergency department presentation, its dynamic change during serial sampling, and the time between the obtaining of samples, was used to estimate the probability of myocardial infarction on emergency department presentation and 30-day outcomes.

AB - Background: Data regarding high-sensitivity troponin concentrations in patients presenting to the emergency department with symptoms suggestive of myocardial infarction may be useful in determining the probability of myocardial infarction and subsequent 30-day outcomes.Methods: In 15 international cohorts of patients presenting to the emergency department with symptoms suggestive of myocardial infarction, we determined the concentrations of high-sensitivity troponin I or high-sensitivity troponin T at presentation and after early or late serial sampling. The diagnostic and prognostic performance of multiple high-sensitivity troponin cutoff combinations was assessed with the use of a derivation–validation design. A risk-assessment tool that was based on these data was developed to estimate the risk of index myocardial infarction and of subsequent myocardial infarction or death at 30 days.Results: Among 22,651 patients (9604 in the derivation data set and 13,047 in the validation data set), the prevalence of myocardial infarction was 15.3%. Lower high-sensitivity troponin concentrations at presentation and smaller absolute changes during serial sampling were associated with a lower likelihood of myocardial infarction and a lower short-term risk of cardiovascular events. For example, high-sensitivity troponin I concentrations of less than 6 ng per liter and an absolute change of less than 4 ng per liter after 45 to 120 minutes (early serial sampling) resulted in a negative predictive value of 99.5% for myocardial infarction, with an associated 30-day risk of subsequent myocardial infarction or death of 0.2%; a total of 56.5% of the patients would be classified as being at low risk. These findings were confirmed in an external validation data set.Conclusions: A risk-assessment tool, which we developed to integrate the high-sensitivity troponin I or troponin T concentration at emergency department presentation, its dynamic change during serial sampling, and the time between the obtaining of samples, was used to estimate the probability of myocardial infarction on emergency department presentation and 30-day outcomes.

KW - Adult

KW - Aged

KW - Biomarkers/blood

KW - Cohort Studies

KW - Emergency Service, Hospital

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/blood

KW - Prognosis

KW - Risk Assessment/methods

KW - Sensitivity and Specificity

KW - Troponin I/blood

KW - Troponin/blood

U2 - 10.1056/NEJMoa1803377

DO - 10.1056/NEJMoa1803377

M3 - Article

C2 - 31242362

VL - 380

SP - 2529

EP - 2540

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 26

ER -

Neumann JT, Twerenbold R, Ojeda F, Sörensen NA, Chapman AR, Shah ASV et al. Application of High-Sensitivity Troponin in Suspected Myocardial Infarction. New England Journal of Medicine. 2019 Jun 27;380(26):2529-2540. https://doi.org/10.1056/NEJMoa1803377