ST elevation myocardial infarction laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

A new clinical evidence based classification system has been jointly introduced by the American College of Cardiology (ACC), American Heart Association (AHA), European Society of Cardiology (ESC), and the World Heart Federation (WHF).[1] The primary diagnostic tests include the electrocardiogram (ECG, EKG) and blood tests to detect elevated creatine kinase or troponin levels (these are chemical markers released by damaged tissues, especially the myocardium).


Four strategies for using troponin levels to diagnose acute myocardial infarction[2]
Strategy Proportion of patients meeting criteria Sensitivity
Limit of detection (hs-cTnI<2 ng/L) 16% 100%
Single cutoff (hs-cTnI<5 ng/L) 54% 97%*
1-hour algorithm (hs-cTnI<5 ng/L and 1-hour change<2 ng/L) 52% 98%
0/1-hour (hs-cTnI < limit of detection and 1-hour change<2 ng/L) (European Society of Cardiology guideline). 52% 98%
* Drops to 94% among patients who present within 2 hours of onset of chest pain.

References

  1. Thygesen K, Alpert JS, White HD (2007). "Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction Joint ESC/ACCF/AHA/WHF". Circulation. 2007: 2634–2653. PMID 17951284. 
  2. Boeddinghaus J, Nestelberger T, Twerenbold R, Wildi K, Badertscher P, Cupa J; et al. (2017). "Direct Comparison of 4 Very Early Rule-Out Strategies for Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin I.". Circulation. 135 (17): 1597–1611. PMID 28283497. doi:10.1161/CIRCULATIONAHA.116.025661. 

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