Identification of acute myocardial infarction in elderly patients using optimized highly sensitive troponin I thresholds

von Jeinsen, Beatrice; Liebetrau, Christoph; Palapies, Lars; Tzikas, Stergios; Zeller, Tanja; Bickel, Christoph; Schmidt, Alexander; Tubaro, Marco; Lackner, Karl J.; Sar, Fachrie; Baldus, Stephan; Zeiher, Andreas M.; Blankenberg, Stefan; Gori, Tommaso; Münzel, Thomas; Hamm, Christian W.; Wild, Philipp S.; Keller, Till

doi:10.6084/m9.figshare.9879281.v1

ibmk_a_1606276_sm4854.pdf (304.51 kB)

Identification of acute myocardial infarction in elderly patients using optimized highly sensitive troponin I thresholds

journal contribution

posted on 2019-09-19, 12:35 authored by Beatrice von Jeinsen, Christoph Liebetrau, Lars Palapies, Stergios Tzikas, Tanja Zeller, Christoph Bickel, Alexander Schmidt, Marco Tubaro, Karl J. Lackner, Fachrie Sar, Stephan Baldus, Andreas M. Zeiher, Stefan Blankenberg, Tommaso Gori, Thomas Münzel, Christian W. Hamm, Philipp S. Wild, Till Keller

Purpose: Established diagnostic thresholds for high-sensitivity cardiac troponins (hs-cTn) might not apply for elderly patients as they are elevated irrespective of the presence of an acute myocardial infarction (AMI). Aim of the present study was to investigate hs-cTnI in elderly patients with suspected AMI and to calculate optimized diagnostic cutoffs.

Material and methods: Data from a prospective multi-centre study and from a second independent prospective single-centre cohort study were analysed. A number of 2903 patients were eligible for further analysis. Patients > 70 years were classified as elderly. hs-cTnI was measured upon admission.

Results: Around 34.7% of 2903 patients were classified as elderly. Around 22.5% of elderly patients were finally diagnosed with AMI. Elderly patients had higher hs-cTnI levels at admission irrespective of the final diagnosis (p < 0.001). According to the AUROC, hs-cTnI was a strong marker for detection of AMI in elderly patients. Application of the 99th percentile cutoffs showed a substantially lower specificity in elderly. By using optimized thresholds, specificity was improved to levels as in younger patients in both cohorts but accompanied with a decrease in sensitivity.

Conclusions: hs-cTnI levels have a lower specificity for detecting AMI in elderly patients. This lower specificity can be improved by using hs-cTnI thresholds optimized for elderly patients.