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

Beatrice von Jeinsen1,2,3, Christoph Liebetrau1,3, Lars Palapies2

  • 1a Department of Cardiology, Kerckhoff Heart Center , Bad Nauheim , Germany.

Biomarkers : Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals
|June 5, 2019
PubMed

Insights

Established high-sensitivity cardiac troponin (hs-cTn) thresholds may misdiagnose acute myocardial infarction (AMI) in elderly patients. Optimized hs-cTnI cutoffs improve diagnostic accuracy in this population.

Area of Science:

  • Cardiology
  • Biomarkers
  • Geriatric Medicine

Background:

  • Established high-sensitivity cardiac troponin (hs-cTn) diagnostic thresholds may not be suitable for elderly patients.
  • Elevated hs-cTn levels in the elderly can occur irrespective of acute myocardial infarction (AMI).

Purpose of the Study:

  • To investigate hs-cTnI levels in elderly patients with suspected AMI.
  • To determine optimized diagnostic cutoffs for hs-cTnI in elderly individuals.

Main Methods:

  • Analysis of data from two prospective studies (multi-centre and single-centre).
  • Inclusion of 2903 patients, with a focus on those over 70 years old (elderly).
  • Measurement of hs-cTnI upon admission.

Main Results:

  • Elderly patients (34.7% of cohort) showed higher hs-cTnI levels regardless of AMI diagnosis (p < 0.001).
  • Standard 99th percentile cutoffs demonstrated lower specificity for AMI detection in the elderly.
  • Optimized thresholds improved specificity in elderly patients, comparable to younger cohorts, albeit with reduced sensitivity.

Conclusions:

  • hs-cTnI exhibits lower specificity for AMI detection in elderly patients.
  • Utilizing hs-cTnI thresholds optimized for the elderly can enhance diagnostic specificity.

Keywords:
Acute myocardial infarctionagebiomarkerselderlytroponin

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