Diagnostic Accuracy of High-Sensitive Troponin for the Identification of Myocardial Infarction in Patients Presenting with Acute Heart Failure

• Published in: The Journal of emergency medicine 2022-03, Vol.62 (3), p.359-367
• Main Authors: Ledwoch, Jakob, Schneider, Alisa, Leidgschwendner, Katharina, Kraxenberger, Jana, Krauth, Anna, Schneider, Vera, Martens, Eimo, Müller, Alexander, Laugwitz, Karl-Ludwig, Kupatt, Christian
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Acute heart failure; Biomarkers; Heart Failure - complications; Heart Failure - diagnosis; Humans; Myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Retrospective Studies; Troponin; Troponin T
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2021.11.013

The differentiation of myocardial infarction (MI) in the setting of acute heart failure (AHF) can be challenging because the majority of patients presenting with AHF show elevations of high-sensitive troponin (hs-Tn). Fast identification of MI is crucial to perform timely coronary angiography and to improve clinical outcome. The aim of the present study was to assess the diagnostic accuracy of different levels of hs-Tn for the identification of type 1 MI in patients with AHF. This was a retrospective single-center analysis of admitted AHF patients with documentation of high-sensitive troponin T (hs-TnT). A total of 649 patients were enrolled into the present study. Of them, 18% had type 1 MI, 7% had type 2 MI, 69% had myocardial injury, and 6% had no myocardial injury. The area under the curve of hs-TnT for the prediction of type 1 MI was 0.70. Sensitivity and specificity of the hs-TnT 99th percentile upper reference limit (URL) for type 1 MI was 100% and 8%, respectively. The Youden index derived cut-off of hs-TnT was 50 ng/L, showing a sensitivity and specificity for type 1 MI of 63% and 68%, respectively. No significant difference regarding 30-day mortality was found depending on the presence of type 1 MI (odds ratio 1.86; 95% confidence interval 0.91–3.81). Hs-TnT-based identification of type 1 MI in patients with AHF requires higher cut-offs compared with the 99th percentile URL used in overall acute coronary syndrome populations. However, the adjusted cut-off provided only moderate sensitivity and specificity.