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Journal Article•DOI•

Validation of High-Sensitivity Troponin I in a 2-Hour Diagnostic Strategy to Assess 30-Day Outcomes in Emergency Department Patients With Possible Acute Coronary Syndrome

Louise Cullen1, Louise Cullen2, Christian Mueller3, William A. Parsonage4, William A. Parsonage2, Karin Wildi3, Jaimi H. Greenslade4, Jaimi H. Greenslade2, Jaimi H. Greenslade1, Raphael Twerenbold3, Sally Aldous5, B. Meller3, Jillian R Tate2, Tobias Reichlin6, Christopher J. Hammett2, Christa Zellweger3, Jacobus P.J. Ungerer2, Maria Rubini Gimenez3, Richard W. Troughton7, Karsten Murray3, Anthony F T Brown2, Mira Mueller3, Peter M. George5, Tamina Mosimann3, Dylan Flaws4, Miriam Reiter3, Arvin Lamanna2, Philip Haaf3, Chris J. Pemberton7, A. Mark Richards7, Kevin Chu2, Christopher M. Reid8, William F. Peacock9, Allan S. Jaffe10, Christopher M. Florkowski5, Joanne M. Deely, Martin Than5 •
Queensland University of Technology1, Royal Brisbane and Women's Hospital2, University Hospital of Basel3, University of Queensland4, Christchurch Hospital5, Brigham and Women's Hospital6, University of Otago7, Monash University8, Baylor College of Medicine9, Mayo Clinic10
01 Oct 2013-Journal of the American College of Cardiology (Elsevier)-Vol. 62, Iss: 14, pp 1242-1249
TL;DR: An early-discharge strategy using an hs-TnI assay and TIMI score ≤ 1 had similar safety as previously reported, with the potential to decrease the observation periods and admissions for approximately 40% of patients with suspected ACS.
About: This article is published in Journal of the American College of Cardiology.The article was published on 2013-10-01 and is currently open access. It has received 255 citations till now. The article focuses on the topics: Mace & Acute coronary syndrome.
Citations
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Journal Article•DOI•
Fourth Universal Definition of Myocardial Infarction (2018).

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Kristian Thygesen, Joseph S. Alpert1, Allan S. Jaffe, Bernard R. Chaitman, Jeroen J. Bax, David A. Morrow, Harvey D. White2 •
University of Arizona1, Auckland City Hospital2
30 Oct 2018-European Heart Journal
TL;DR: This dissertation aims to provide a history of web exceptionalism from 1989 to 2002, a period chosen in order to explore its roots as well as specific cases up to and including the year in which descriptions of “Web 2.0” began to circulate.
Abstract: Kristian Thygesen∗ (Denmark) Joseph S. Alpert∗ (USA) Allan S. Jaffe (USA) Bernard R. Chaitman (USA) Jeroen J. Bax (The Netherlands) David A. Morrow (USA) Harvey D. White∗ (New Zealand) Hans Mickley (Denmark) Filippo Crea (Italy) Frans Van de Werf (Belgium) Chiara Bucciarelli-Ducci (

3,355 citations

Journal Article•DOI•
High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study

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Anoop S V Shah1, Atul Anand1, Yader Sandoval2, Kuan Ken Lee1, Stephen W. Smith2, Stephen W. Smith3, Philip D Adamson1, Andrew R. Chapman1, Timothy Langdon1, Dennis Sandeman1, Amar Vaswani1, Fiona E. Strachan1, Amy V. Ferry1, Alexandra G Stirzaker1, Alan Reid, Alasdair Gray, Paul O. Collinson4, David A. McAllister1, Fred S. Apple3, David E. Newby1, Nicholas L. Mills1 •
University of Edinburgh1, Hennepin County Medical Center2, University of Minnesota3, St George's, University of London4
19 Dec 2015-The Lancet
TL;DR: Low plasma troponin concentrations identify two-thirds of patients at very low risk of cardiac events who could be discharged from hospital, and could substantially reduce hospital admissions and have major benefits for both patients and health-care providers.

426 citations

Journal Article•DOI•
2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

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Martha Gulati, Phillip D. Levy, Debabrata Mukherjee, Ezra A. Amsterdam, Deepak L. Bhatt, Kim K. Birtcher, Ron Blankstein, Jack H. Boyd, Renee P. Bullock-Palmer, Theresa Conejo, Deborah B. Diercks, Federico Gentile, John P Greenwood, Erik P. Hess, Steven M. Hollenberg1, Wael A Jaber2, Hani Jneid, Jose A. Joglar, David A. Morrow, Robert E. O'Connor, Michael A. Ross, Leslee J. Shaw •
American College of Chest Physicians1, American Society of Echocardiography2
30 Nov 2021-Journal of the American College of Cardiology
TL;DR: The 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain this paper provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain.

402 citations

Journal Article•DOI•
JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome.

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Kazuo Kimura1, Takeshi Kimura2, Masaharu Ishihara3, Yoshihisa Nakagawa4, Koichi Nakao, Katsumi Miyauchi, Tomohiro Sakamoto, Kenichi Tsujita5, Nobuhisa Hagiwara, Shunichi Miyazaki6, Junya Ako7, Hirokuni Arai8, Hideki Ishii9, Hideki Origuchi, Wataru Shimizu10, Hirofumi Takemura11, Yoshio Tahara, Yoshihiro Morino12, Kenji Iino11, Tomonori Itoh12, Yoshitaka Iwanaga6, Keiji Uchida1, Hirohisa Endo13, Ken Kongoji14, Kenji Sakamoto5, Hiroki Shiomi2, Takao Shimohama7, Atsushi Suzuki, Jun Takahashi15, Ichiro Takeuchi1, Akihito Tanaka9, Toshihiro Tamura16, Takahiro Nakashima, Teruo Noguchi, Daisuke Fukamachi17, Tomohiro Mizuno8, Junichi Yamaguchi, Kenji Yodogawa10, Masami Kosuge1, Shun Kohsaka18, Hideaki Yoshino14, Satoshi Yasuda, Hiroaki Shimokawa15, Atsushi Hirayama17, Takashi Akasaka19, Kazuo Haze, Hisao Ogawa, Hiroyuki Tsutsui20, Tsutomu Yamazaki21 •
Yokohama City University Medical Center1, Kyoto University2, Hyogo College of Medicine3, Shiga University of Medical Science4, Kumamoto University5, Kindai University6, Kitasato University7, Tokyo Medical and Dental University8, Nagoya University9, Nippon Medical School10, Kanazawa University11, Iwate Medical University12, Juntendo University13, Kyorin University14, Tohoku University15, Tenri Hospital16, Nihon University17, Keio University18, Wakayama Medical University19, Kyushu University20, International University of Health and Welfare21
25 Apr 2019-Circulation
TL;DR: This document is an English version of JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome reported at the Japanese Circulation Society Joint Working Groups performed in 2018.
Abstract: J-STAGE Advance Publication released online March 29, 2019 Mailing address: Scientific Committee of the Japanese Circulation Society, 18F Imperial Hotel Tower, 1-1-1 Uchisaiwai-cho, Chiyoda-ku, Tokyo 100-0011, Japan. E-mail: meeting@j-circ.or.jp This document is an English version of JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome reported at the Japanese Circulation Society Joint Working Groups performed in 2018. (Website: http://www.j-circ.or.jp/guideline/pdf/JCS2018_ kimura.pdf). *Chairperson. Refer to Appendix 1 for the details of members. Joint Working Groups: The Japanese Circulation Society, the Japanese Association for Thoracic Surgery, the Japanese Association of Cardiac Rehabilitation, the Japanese Association of Cardiovascular Intervention and Therapeutics, the Japanese College of Cardiology, the Japanese Coronary Association, the Japanese Heart Rhythm Society, the Japanese Society for Cardiovascular Surgery, the Japanese Society of Intensive Care Medicine ISSN-1346-9843 All rights are reserved to the Japanese Circulation Society. For permissions, please e-mail: cj@j-circ.or.jp JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome

302 citations

Journal Article•DOI•
Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T.

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Christian Mueller1, Evangelos Giannitsis2, Michael Christ3, Jorge Ordonez-Llanos, Christopher DeFilippi4, James McCord5, Richard Body6, Mauro Panteghini7, Tomas Jernberg8, Mario Plebani, Franck Verschuren9, John K. French10, Robert H. Christenson4, Silvia Weiser11, Garnet Bendig11, Peter Dilba11, Bertil Lindahl12 •
University Hospital of Basel1, University Hospital Heidelberg2, Paracelsus Private Medical University of Salzburg3, University of Maryland, Baltimore4, Henry Ford Health System5, Central Manchester University Hospitals NHS Foundation Trust6, University of Milan7, Karolinska Institutet8, Université catholique de Louvain9, University of New South Wales10, Hoffmann-La Roche11, Uppsala University12
01 Jul 2016-Annals of Emergency Medicine
TL;DR: The recently developed 0-h/1-h algorithm, using high-sensitivity cardiac troponin T (hs-cTnT) for the early rule-out and rule-in of acute myocardial infarction performs well.

293 citations

Cites result from "Validation of High-Sensitivity Trop..."

  • ...Thereby, the hs-cTnT 0-hour/1-hour algorithm seemed to be even more complete and more effective in the early triage of acute chest pain patients than other important emerging early triage strategies in similar study populations.(18,20,24-28) This difference is at least partly explained by the fact that the latter exclusively selects patients for rule-out, but does not provide guidance for rule-in....

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References
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Journal Article•DOI•
Universal definition of myocardial infarction

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Kristian Thygesen1, Joseph S. Alpert2, Harvey D. White3•
Aarhus University Hospital1, University of Arizona2, Auckland City Hospital3
27 Nov 2007-Circulation
TL;DR: The past history, and likely future of this important topic has been/will remain more “evolution” than “big-bang”, and the current redefinition was flawed at inception owing to a fundamental problem with the troponin assays available at that time.
Abstract: Myocardial infarction is a major cause of death and disability worldwide. Coronary atherosclerosis is a chronic disease with stable and unstable periods. During unstable periods with activated inflammation in the vascular wall, patients may develop a myocardial infarction. Myocardial infarction may be a minor event in a lifelong chronic disease, it may even go undetected, but it may also be a major catastrophic event leading to sudden death or severe hemodynamic deterioration. A myocardial infarction may be the first manifestation of coronary artery disease, or it may occur, repeatedly, in patients with established disease. Information on myocardial infarction attack rates can provide useful data regarding the burden of coronary artery disease within and across populations, especially if standardized data are collected in a manner that demonstrates the distinction between incident and recurrent events. From the epidemiological point of view, the incidence of myocardial infarction in a population can be used as a proxy for the prevalence of coronary artery disease in that population. Furthermore, the term myocardial infarction has major psychological and legal implications for the individual and society. It is an indicator of one of the leading health problems in the world, and it is an outcome measure in clinical trials and observational studies. With these perspectives, myocardial infarction may be defined from a number of different clinical, electrocardiographic, biochemical, imaging, and pathological characteristics. In the past, a general consensus existed for the clinical syndrome designated as myocardial infarction. In studies of disease prevalence, the World Health Organization (WHO) defined myocardial infarction from symptoms, ECG abnormalities, and enzymes. However, the development of more sensitive and specific serological biomarkers and precise imaging techniques allows detection of ever smaller amounts of myocardial necrosis. Accordingly, current clinical practice, health care delivery systems, as well as epidemiology and clinical trials all require a …

3,774 citations

Journal Article•
Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction

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K Thygesen
01 Jan 2007-Circulation

3,129 citations

Journal Article•DOI•
The TIMI Risk Score for Unstable Angina/Non–ST Elevation MI: A Method for Prognostication and Therapeutic Decision Making

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Elliott M. Antman1, Marc Cohen2, Peter J.L.M Bernink3, Carolyn H. McCabe, Thomas Horacek, Gary Papuchis, Branco Mautner, Ramón Corbalán, David Radley, Eugene Braunwald •
Brigham and Women's Hospital1, American Medical Association2, Harvard University3
16 Aug 2000-JAMA
TL;DR: In patients with UA/NSTEMI, the TIMI risk score is a simple prognostication scheme that categorizes a patient's risk of death and ischemic events and provides a basis for therapeutic decision making.
Abstract: ContextPatients with unstable angina/non–ST-segment elevation myocardial infarction (MI) (UA/NSTEMI) present with a wide spectrum of risk for death and cardiac ischemic events.ObjectiveTo develop a simple risk score that has broad applicability, is easily calculated at patient presentation, does not require a computer, and identifies patients with different responses to treatments for UA/NSTEMI.Design, Setting, and PatientsTwo phase 3, international, randomized, double-blind trials (the Thrombolysis in Myocardial Infarction [TIMI] 11B trial [August 1996–March 1998] and the Efficacy and Safety of Subcutaneous Enoxaparin in Unstable Angina and Non-Q-Wave MI trial [ESSENCE; October 1994–May 1996]). A total of 1957 patients with UA/NSTEMI were assigned to receive unfractionated heparin (test cohort) and 1953 to receive enoxaparin in TIMI 11B; 1564 and 1607 were assigned respectively in ESSENCE. The 3 validation cohorts were the unfractionated heparin group from ESSENCE and both enoxaparin groups.Main Outcome MeasuresThe TIMI risk score was derived in the test cohort by selection of independent prognostic variables using multivariate logistic regression, assignment of value of 1 when a factor was present and 0 when it was absent, and summing the number of factors present to categorize patients into risk strata. Relative differences in response to therapeutic interventions were determined by comparing the slopes of the rates of events with increasing score in treatment groups and by testing for an interaction between risk score and treatment. Outcomes were TIMI risk score for developing at least 1 component of the primary end point (all-cause mortality, new or recurrent MI, or severe recurrent ischemia requiring urgent revascularization) through 14 days after randomization.ResultsThe 7 TIMI risk score predictor variables were age 65 years or older, at least 3 risk factors for coronary artery disease, prior coronary stenosis of 50% or more, ST-segment deviation on electrocardiogram at presentation, at least 2 anginal events in prior 24 hours, use of aspirin in prior 7 days, and elevated serum cardiac markers. Event rates increased significantly as the TIMI risk score increased in the test cohort in TIMI 11B: 4.7% for a score of 0/1; 8.3% for 2; 13.2% for 3; 19.9% for 4; 26.2% for 5; and 40.9% for 6/7 (P<.001 by χ2 for trend). The pattern of increasing event rates with increasing TIMI risk score was confirmed in all 3 validation groups (P<.001). The slope of the increase in event rates with increasing numbers of risk factors was significantly lower in the enoxaparin groups in both TIMI 11B (P = .01) and ESSENCE (P = .03) and there was a significant interaction between TIMI risk score and treatment (P = .02).ConclusionsIn patients with UA/NSTEMI, the TIMI risk score is a simple prognostication scheme that categorizes a patient's risk of death and ischemic events and provides a basis for therapeutic decision making.

3,048 citations

"Validation of High-Sensitivity Trop..." refers methods in this paper

  • ...The TIMI risk score for unstable angina or non–STsegment elevationmyocardial infarction uses 7 predictors with a value of 1 point assigned for each positive finding (11)....

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  • ...The TIMI score was established for the risk stratification of patients with ACS and divides patients into prognostic categories that enable targeted management according to the level of risk (11)....

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Journal Article•DOI•
Early diagnosis of myocardial infarction with sensitive cardiac troponin assays.

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Tobias Reichlin1, Willibald Hochholzer1, Stefano Bassetti2, Stefano Bassetti1, Stephan Steuer, Claudia Stelzig, Sabine Hartwiger, Stefan Biedert, Nora Schaub, Christine Buerge, Mihael Potocki, Markus Noveanu, Tobias Breidthardt, Raphael Twerenbold1, Katrin Winkler, Roland Bingisser, Christian Mueller1 •
University Hospital of Basel1, University of Bern2
10 Dec 2009-The New England Journal of Medicine
TL;DR: The diagnostic performance of sensitive cardiac troponin assays is excellent, and these assays can substantially improve the early diagnosis of acute myocardial infarction, particularly in patients with a recent onset of chest pain.
Abstract: cantly higher with the four sensitive cardiac troponin assays than with the standard assay (AUC for Abbott–Architect Troponin I, 0.96; 95% confidence interval [CI], 0.94 to 0.98; for Roche High-Sensitive Troponin T, 0.96; 95% CI, 0.94 to 0.98; for Roche Troponin I, 0.95; 95% CI, 0.92 to 0.97; and for Siemens Troponin I Ultra, 0.96; 95% CI, 0.94 to 0.98; vs. AUC for the standard assay, 0.90; 95% CI, 0.86 to 0.94). Among patients who presented within 3 hours after the onset of chest pain, the AUCs were 0.93 (95% CI, 0.88 to 0.99), 0.92 (95% CI, 0.87 to 0.97), 0.92 (95% CI, 0.86 to 0.99), and 0.94 (95% CI, 0.90 to 0.98) for the sensitive assays, respectively, and 0.76 (95% CI, 0.64 to 0.88) for the standard assay. We did not assess the effect of the sensitive troponin assays on clinical management. Conclusions The diagnostic performance of sensitive cardiac troponin assays is excellent, and these assays can substantially improve the early diagnosis of acute myocardial infarction, particularly in patients with a recent onset of chest pain. (ClinicalTrials. gov number, NCT00470587.)

1,612 citations

"Validation of High-Sensitivity Trop..." refers background or methods in this paper

  • ...Figure 1 ADAPT and APACE Cohort-Participant Flow Diagrams for th Shown are the ADAPT (Accelerated Diagnostic protocol to Assess Patients with chest Pa (Advantageous Predictors of Acute Coronary Syndromes Evaluation) (right) flow diagrams sensitivity troponin T; MACE ¼ major adverse cardiac event(s); TIMI ¼ Thrombolysis In M Further objective investigations within the 30-day period, including exercise stress testing, echocardiography, computed tomography coronary angiography, and angiography, were performed in 246 patients (76.9...

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  • ...Most patients recruited were Caucasian, limiting the generalizability of the results to other populations; however, the studies were conducted in 2 Table 5 Participants With Detectable Troponin Values (>1.2 ng/l) on Presentation n % ADAPT cohort 1,551 94.9 APACE cohort 873 96.0 ADAPT ¼ Accelerated Diagnostic protocol to Assess Patients with chest Pain symptoms using contemporary troponin as the only biomarker; APACE¼ Advantageous Predictors of Acute Coronary Syndromes Evaluation. geographically distinct regions....

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  • ...The ADAPT substudy was performed in accordance with details registered with the ACTRN12611001069943 (8) and APACE (NCT00470587) (3,13)....

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  • ...In the APACE cohort, consecutive adult patients were prospectively recruited who presented to the emergency departments in a multinational, multicenter study with symptoms suggestive of AMI with onset or peak symptoms within the previous 12 h (3)....

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  • ...(Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study, NCT00470587; A 2hr Accelerated Diagnostic Protocol to Assess patients with chest Pain symptoms using contemporary Troponins as the only biomarker [ADAPT]: a prospective observational validation study, ACTRN12611001069943) (J Am Coll Cardiol 2013;62:1242–9) ª 2013 by the American College of Cardiology Foundation Abbreviations and Acronyms ACS = acute coronary syndrome(s) ADP = accelerated diagnostic protocol AMI = acute myocardial infarction CI = confidence interval ECG = electrocardiography hs-TnI = high-sensitivity troponin I MACE = major adverse cardiac event(s) TIMI = Thrombolysis In Myocardial Infarction JACC Vol. 62, No. 14, 2013 Cullen et al. October 1, 2013:1242–9 hs-Troponin I Strategy for Chest Pain 1243 High-sensitivity troponin (hs-Tn) assays have shown excellent diagnostic performance in the evaluation of patients with possible acute myocardial infarction (AMI) (1–3)....

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Journal Article•DOI•
Analytical Characteristics of High-Sensitivity Cardiac Troponin Assays

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Fred S. Apple1, Paul O. Collinson2•
Hennepin County Medical Center1, St George's Hospital2
01 Jan 2012-Clinical Chemistry
TL;DR: This review raises important points regarding cTNI and cTnT assays and their reference limits and specifically addresses hs assays used to measure low concentrations (nanograms per liter or picograms per milliliter).
Abstract: BACKGROUND: Cardiac troponins I (cTnI) and T (cTnT) have received international endorsement as the standard biomarkers for detection of myocardial injury, for risk stratification in patients suspected of acute coronary syndrome, and for the diagnosis of myocardial infarction. An evidence-based clinical database is growing rapidly for high-sensitivity (hs) troponin assays. Thus, clarifications of the analytical principles for the immunoassays used in clinical practice are important. CONTENT: The purpose of this mini-review is ( a ) to provide a background for the biochemistry of cTnT and cTnI and ( b ) to address the following analytical questions for both hs cTnI and cTnT assays: ( i ) How does an assay become designated hs? ( ii ) How does one realistically define healthy (normal) reference populations for determining the 99th percentile? ( iii ) What is the usual biological variation of these analytes? ( iv ) What assay imprecision characteristics are acceptable? ( v ) Will standardization of cardiac troponin assays be attainable? SUMMARY: This review raises important points regarding cTnI and cTnT assays and their reference limits and specifically addresses hs assays used to measure low concentrations (nanograms per liter or picograms per milliliter). Recommendations are made to help clarify the nomenclature. The review also identifies further challenges for the evolving science of cardiac troponin measurement. It is hoped that with the introduction of these concepts, both laboratorians and clinicians can develop a more unified view of how these assays are used worldwide in clinical practice.

755 citations

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How to use high-sensitivity cardiac troponins in acute cardiac care

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01 Sep 2012-European Heart Journal
Kristian Thygesen, Johannes Mair, Evangelos Giannitsis, Christian Mueller, Bertil Lindahl, Stefan Blankenberg, Kurt Huber, Mario Plebani, Luigi M. Biasucci, Marco Tubaro, Paul Collinson, Per Venge, Yonathan Hasin, Marcello Galvani, Wolfgang Koenig, Christian Hamm, Joseph S. Alpert, Hugo A. Katus, Allan S. Jaffe