Regular paperDifferences in the diagnosis of myocardial infarction by troponin T compared with clinical and epidemiologic criteria☆
Section snippets
Patients
During the study period (from August 30, 1995, until February 29, 1996), 646 patients with a suspected acute coronary syndrome were admitted to the emergency department of the Kuopio University Hospital. Twenty-two surviving patients were excluded either because of a premature discontinuation of the study protocol (difficulties in drawing a blood sample, returning home after only 1 sample, or transfer to other hospital department) or because of missing biochemical marker measurements. Of the
Comparison of diagnostic classifications
Of the 559 patients, 127 (23%) had a clinical diagnosis of MI. If diagnosis of MI was based on elevated troponin T (>0.10 μg/L), the number of MIs increased up to 169, by 33% compared with a clinical MI diagnosis. Seventeen patients (13%) in whom MI was diagnosed clinically had troponin T ≤0.10 μg/L. Of these 17 patients, 4 (24%) had ST-segment or T-wave changes on the ECG, and 4 (24%) had conventional enzyme activity >1 and ≤2 × the upper reference limit. Ten of the 17 patients (59%) had a
Discussion
Our study of consecutive patients admitted to the hospital with a suspected acute coronary syndrome showed that the diagnosis of MI made on the basis of increased serum troponin T concentration (>0.10 μg/L) increased the total number of patients receiving the diagnosis of MI by 33% compared with the clinical diagnosis, and by 23% compared with the standardized epidemiologic diagnosis. However, there was some crossover to the other direction between the diagnostic classifications; troponin T
Acknowledgements
We thank the personnel of the Accident and Emergency Department and the Department of Clinical Chemistry of the Kuopio University Hospital for their skillful work during the study. We also thank Pertti Palomäki, MD, and Jouko Remes, MD, for their collaboration in the early phases of this study, and Heikki Miettinen, MD, and Veikko Salomaa, MD, for comments on this text.
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This study was supported by grants from the Finnish Foundation for Cardiovascular Research, the University of Kuopio and the Kuopio University Hospital, Kuopio, Finland