Author + information
- Andrew R. Chapman,
- Anoop Shah,
- Atul Anand,
- Philip Adamson,
- Dennis Sandeman,
- Amy Ferry,
- Fiona Strachan,
- David Newby and
- Nicholas Mills
Background: Guidelines recommend classification of myocardial infarction due to plaque rupture (type 1) or myocardial oxygen supply-demand mismatch (type 2). Whether more sensitive cardiac troponin assays can help to differentiate between subtypes is uncertain.
Methods: Consecutive patients (n=4,739) with suspected acute coronary syndrome presenting to the Emergency Department underwent high-sensitivity cardiac troponin I testing on presentation, and at 6 or 12 hours. All diagnoses were adjudicated. We compared peak and absolute change in troponin concentration on serial testing by subtypes. Logistic regression models were derived for type 1 versus type 2 myocardial infarction using peak concentration alone, or in combination with absolute change.
Results: Type 1 myocardial infarction occurred in 13.7% (651/4,739), type 2 in 3.7% (173/4,739), and myocardial injury in 6.3% (301/4,739) of patients. The distribution of peak troponin concentration differed between patients with myocardial infarction and myocardial injury (A), and small differences in the rate of change on serial testing were observed (B). Peak troponin concentration provided modest discrimination between subtypes (AUC 0.60 [95%CI 0.55-0.65]), but the addition of absolute change in concentration did not improve the model (AUC 0.62 [95%CI 0.57-0.68]).
Conclusions: Peak troponin concentration, but not absolute change, may help to distinguish between type 1 and type 2 myocardial infarction in clinical practice.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Coronary Syndromes, Diagnosis, Management and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1253-346
- 2017 American College of Cardiology Foundation