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Diagnosis

Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

Editor-in-Chief: Graber, Mark L. / Plebani, Mario

Ed. by Argy, Nicolas / Epner, Paul L. / Lippi, Giuseppe / Singhal, Geeta / McDonald, Kathryn / Singh, Hardeep / Newman-Toker, David

Editorial Board: Basso , Daniela / Crock, Carmel / Croskerry, Pat / Dhaliwal, Gurpreet / Ely, John / Giannitsis, Evangelos / Katus, Hugo A. / Laposata, Michael / Lyratzopoulos, Yoryos / Maude, Jason / Sittig, Dean F. / Sonntag, Oswald / Zwaan, Laura


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Strategies to overcome misdiagnosis of type 1 myocardial infarction using high sensitive cardiac troponin assays

Beatrice von Jeinsen
  • Department of Internal Medicine III, Division of Cardiology, Goethe University Frankfurt, Frankfurt, Germany
  • German Centre for Cardiovascular Research (DZHK), Partnersite RheinMain, Frankfurt, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Till Keller
  • Corresponding author
  • Department of Internal Medicine III, Division of Cardiology, Goethe University Frankfurt, Frankfurt, Germany
  • German Centre for Cardiovascular Research (DZHK), Partnersite RheinMain, Frankfurt, Germany
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2016-11-24 | DOI: https://doi.org/10.1515/dx-2016-0022

Abstract

High sensitive cardiac troponin assays have become the gold standard in the diagnosis of an acute type 1 myocardial infarction (MI) in the absence of ST-segment elevation. Several acute or chronic conditions that impact cardiac troponin levels in the absence of a MI might lead to a misdiagnosis of MI. For example, patients with impaired renal function as well as elderly patients often present with chronically increased cardiac troponin levels. Therefore, the diagnosis of MI type 1 based on the 99th percentile upper limit of normal threshold is more difficult in these patients. Different diagnostic approaches might help to overcome this limitation of reduced MI specificity of sensitive troponin assays. First, serial troponin measurement helps to differentiate chronic from acute troponin elevations. Second, specific diagnostic cut-offs, optimized for a particular patient group, like elderly patients, are able to regain specificity. Such an individualized use and interpretation of sensitive cardiac troponin measurements improves diagnostic accuracy and reduces the amount of misdiagnosed MI type 1.

Keywords: acute myocardial infarction (AMI); diagnosis; misdiagnosis; NSTEMI; troponin; type 1 myocardial infarction

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About the article

Corresponding author: Till Keller, MD, FESC, Department of Internal Medicine III, Division of Cardiology, Goethe University Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany, Phone: +49 (0) 69 6301 7387, Fax: +49 (0) 69 6301 6546


Received: 2016-06-30

Accepted: 2016-11-01

Published Online: 2016-11-24

Published in Print: 2016-12-01


Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


Citation Information: Diagnosis, Volume 3, Issue 4, Pages 189–198, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2016-0022.

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