Troponin-Test im Alltag

Beeinflussung der Gütekriterien durch Leitsymptome und Unterschiede des Outcomes von Patienten mit auffälligem Test und Patienten mit unauffälligem Test

Troponin test in clinical daily practice

Influence of key symptoms on quality criteria and differences in the outcome of patients with abnormal tests and patients with normal tests

by Mohammad Al Mawed
Doctoral thesis
Date of Examination:2022-04-19
Date of issue:2022-04-01
Advisor:Prof. Dr. Ulrich, Tebbe
Referee:Prof. Dr. Ulrich, Tebbe
Referee:PD Dr. Dr. Moritz Thomas, Schnelle
Persistent Address: http://dx.doi.org/10.53846/goediss-9125

 

 

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Abstract

English

Abstract Introduction  Cardiac troponins are the prefered cardial biomarker in the diagnosis of acute myocardial infarction. With the new Troponin-Assays minimal troponin concentration can be detectable. This makes the interpretation of a positive test very difficult, taking to consideration the wide variety of causes of troponin release. The aim of this study is to assess the quality criteria of the troponin test in the diagnosis of acute myocardial infarction in everyday life and asses the influence of leading symptom on the quality criteria of the test. Methods  This is a retrospective cross-sectional study, patients, who presented themselves in the emergency department of the Klinikum Lippe-Detmold between 01.01.2014 and 31.05.2014, and had a Troponin-I test, were included. The diagnosis “acute myocardial infarction” referred to myocardial infarction type I and was made by the cardiologist on-duty. The patients were divided into four subgroups according to their leading symptoms. The quality criteria of the Troponin-test were calculated. Results  1046 patients were included. In 15 %, acute myocardial infarction was present, of which 97 % had thoracic pain. The sensitivities and the negative predictive values were over 90 %. The specificities ranged between 56 % and 81 %. The positive predictive values were modest and best in case of thoracic pain 58 %. Conclusion  The Troponin test had a good negative predictive value for all clinical symptoms. Thus, an acute myocardial infarction could be excluded with high precision. However, the positive predictive value was low. The only direct symptom that achieved acceptable levels was thoracic pain.
Keywords: cardiac troponins - acute myocardial infarction - myocardial injury - thoracic pain - dyspnea
Schlagwörter: kardiale Troponine - akuter Myokardinfarkt - Myokardverletzung - thorakale Schmerzen - Dyspnoe
 
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