High Sensitivity Troponin Improves Management. But Not Yet
|
|
|
- Andrea Austin
- 6 years ago
- Views:
Transcription
1 High Sensitivity Troponin Improves Management But Not Yet Allan S. Jaffe, MD.* Consultant - Cardiology & Laboratory Medicine Professor of Medicine Chair, CCLS Division, Department of Laboratory Medicine and Pathology Mayo Clinic and Medical School Rochester, Minnesota *Dr. Jaffe is or has been a consultant to most of the major diagnostic companies as well as Pfizer and Amgen. CP
2 AUC More Diagnoses with Higher-Sensitivity Assays 1.0 Sensitive troponin I 99 th % value Troponin T 10%CV value NEJM 361:868, to <3 3 to <6 6 to <9 9 to < All Time of chest-pain onset (hr) Diagnosis of AMI (no.) Single determination (no.) Sensitive troponin I >0.04 ng/ml Troponin T >0.03 ng/ml CP
3 Area under the ROC curve Accuracy by Time of Admission th % value NEJM 361:858, 2009 Mostly same assays but < 99 th % value cut off used Abbott-architect troponin I Roche high-sensitive troponin T Roche troponin I Siemens troponin I ultra Standard assay All patients Hours since onset of symptoms CP
4 Sensitivity Diagnostic Increases in ctn (Christchurch ED Trial) 1.0 Baseline Total Hs TnT Abbott TnT CKMB Reference line specificity specificity Aldous et al: Ann Clin Biochem 48:241, 2011 CP
5 Diagnosis of NSTEMI and Unstable Angina % CV 99 th % hsctnt Non-ACS (n=174) 0 UA (n=101) 23.8 NSTEMI (n=83) Ordonez, TUSCA CP
6 Diagnostic Increases in ctn (Christchurch ED Trial) hs TnT Tnl 3 TnT 100 Baseline 100 Total >10 n=20 n=26 n=9 n=8 n=7 n=18 Aldous et al: Ann Clin Biochem 48:241, >10 CP
7 Prevalence of Detectable Cardiac Troponin T ( 3 ng/l) and levels greater the 99 th percentile value ( 14 ng/l). ctnt Level, ng/ml Sample Sample Sample Weight-Adjusted Weight-Adjusted Size, Prevalence, % Prevalence, Group No. No. (%) (95% Cl) No. (%) 95% Cl) Overall population (27.0) 25.0 ( ) Restricted population Without CHD (26.0) 24.2 ( ) Without cardiovascular disease (24.8) 23.7 ( ) Without cardiovascular disease or CKD a Without cardiovascular disease, CKD, subclinical heart disease, diabetes, or hypertension b (24.0) 23.1 ( ) (20.0) 19.3 ( ) 122 (3.4) 103 (3.0) 2.0 ( ) 1.8 ( ) 82 (2.5) 1.9 ( ) 65 (2.3) 1.2 ( ) 43 (1.7) 1.1 ( ) CP
8 Cumulative incidence of overall death (%) Total Mortality by ctnt Values All-Cause Mortality ctnt Detectable Undetectable ctnt category, ng/ml < <0.003 (undetectable) No. at risk Months ctnt Detectable Undetectable 2,589 2,584 2,576 2,570 2,554 2,552 1, Months No. at risk < < ,589 2,584 2,576 2,570 2,554 2,552 1,995 P<0.001 for all between-group comparisons by the log-rank test; detectable cardiac troponin T (ctnt) levels are ng/ml or greater by the highly sensitive assay; Y-axes shown in blue indicate the range from 0% to 20% JAMA 304(22):2503, 2010 CP
9 hsctnt and Chronic CAD hsctnt in Men vs Women hs-ctnt (ng/l) No CAD Mild Moderate Severe Multi Laufer et al: Arterioscler Thromb Vasc Biol 30:1272, 2010 CP
10 Death and Hospitalization and hstnt at Baseline 10 Mortality Hospitalization for HF Hazard ratio (95% CI) 1 Latini et al: Circ 116, Deciles CP
11 SENSITIVITIES AND SPECIFICITIES INCORPORATING DELTA TROPONINS n = 332, (%) Number positive Sensitivity Specificity hstnt > 99 th centile at peak 143 (43.1) 90.9 ( ) 80.6 ( ) + 20% delta 93 (28.0) 71.8 ( ) 93.7 ( ) + 50% delta 75 (22.6) 61.8 ( ) 96.8 ( ) Tnl 3 > 99 th centile at peak 129 (38.9) 90.0 ( ) 86.5 ( ) + 20% delta 100 (30.1) 74.5 ( ) 91.9 ( ) + 50% delta 88 (26.5) 68.2 ( ) 94.1 ( ) TnT > 99 th centile at peak 108 (32.5) 83.6 ( ) 92.8 ( ) + 20% delta 91 (27.4) 72.7 ( ) 95.0 ( ) + 50% delta 79 (23.8) 65.5 ( ) 96.8 ( ) Reference: Ann Clin Bioch 2011;48(3): CP
12 SENSITIVITIES AND SPECIFICITIES INCORPORATING DELTA TROPONINS n = 332, (%) Number positive Sensitivity Specificity hstnt > 99 th centile at peak 143 (43.1) 90.9 ( ) 80.6 ( ) + 20% delta 93 (28.0) 71.8 ( ) 93.7 ( ) + 50% delta 75 (22.6) 61.8 ( ) 96.8 ( ) Tnl 3 > 99 th centile at peak 129 (38.9) 90.0 ( ) 86.5 ( ) + 20% delta 100 (30.1) 74.5 ( ) 91.9 ( ) + 50% delta 88 (26.5) 68.2 ( ) 94.1 ( ) TnT > 99 th centile at peak 108 (32.5) 83.6 ( ) 92.8 ( ) + 20% delta 91 (27.4) 72.7 ( ) 95.0 ( ) + 50% delta 79 (23.8) 65.5 ( ) 96.8 ( ) Reference: Ann Clin Bioch 2011;48(3): CP
13 SENSITIVITIES AND SPECIFICITIES INCORPORATING DELTA TROPONINS n = 332, (%) Number positive Sensitivity Specificity hstnt > 99 th centile at peak 143 (43.1) 90.9 ( ) 80.6 ( ) + 20% delta 93 (28.0) 71.8 ( ) 93.7 ( ) + 50% delta 75 (22.6) 61.8 ( ) 96.8 ( ) Tnl 3 > 99 th centile at peak 129 (38.9) 90.0 ( ) 86.5 ( ) + 20% delta 100 (30.1) 74.5 ( ) 91.9 ( ) + 50% delta 88 (26.5) 68.2 ( ) 94.1 ( ) TnT > 99 th centile at peak 108 (32.5) 83.6 ( ) 92.8 ( ) + 20% delta 91 (27.4) 72.7 ( ) 95.0 ( ) + 50% delta 79 (23.8) 65.5 ( ) 96.8 ( ) Reference: Ann Clin Bioch 2011;48(3): CP
14 Short-Term Biological Variability in ctnl Participant no Clin Chem 55:1, ctnl (ng/l) CP
15 Use of high sensitivity troponin T to diagnose myocardial infarction Clinical setting consistent with myocardial ischemia Baseline < 14 ng/l ng/l 53 ng/l Retest hstnt 3 hours after symptom onset or if timing of symptom onset is unclear at 6 hours after presentation Retest hstnt 3 hours later Change < 50% Change 50% Retest hstnt 3 hours later Change < 20% Change 20% 14ng/L rules out MI with >90% probability If 14ng/L then proceed to middle part of algorithm. Adverse Prognosis Retest hstnt at 6,12 hr Evidence based treatments Myocardial infarction CP White HD; AHJ 2010
16 Short- and Long-term Bio variation in hsctnt Analytical variation Short Term Long term CVA, % Biological Variation CVI, % 48.2 CVG, % 85.9 Index of Individuality 84.5 RCV, log-normal increase, % CP
17 sensitivity ROC Analysis for 1- and 2-Hour Change specificity 1-specificity hs-ctnt 1h absolute change ( ) AUC 0.93 ctnl Ultra 1h absolute change ( ) AUC 0.94 hs-ctnt 1h relative change ( %) AUC 0.66 ctnl Ultra 1h relative change ( ) AUC 0.64 hs-ctnt 2h absolute change ( ) AUC 0.95 ctnl Ultra 2h absolute change ( ) AUC 0.95 hs-ctnt 2h relative change ( %) AUC 0.76 ctnl Ultra 2h relative change ( ) AUC 0.72 Reichlin et al: Circulation 124:135, 2011 CP
18 CP
19 Myocardial Infarction Type 2 Myocardial infarction secondary to ischemia due to either increased oxygen demand or decreased supply in a setting where coronary supply is at least some part of the problem, e.g. spasm, fixed coronary artery disease, endothelial dysfunction. CP
20 TACTICS (TIMI 18) Cardiac troponin T Conservative Invasive No. treatment treatment Primary endpoint <0.1 ng/ml < < Favors invasive treatment Favors Conservative treatment Death or MI <0.1 ng/ml < < JAMA 286:2405, Odds ratio CP CP
21 30 20 Any Marker Positive (n=442) P=0.03 Outcomes by Gender Women TACTICS-TIMI 18 No Marker Positive (n=173) Rehosp Death/MI P=0.02 Any Marker Positive (n=885) P=0.002 Men No Marker Positive (n=297) P=NS % 10 0 Invasive P=NS Conservative Invasive P=NS Conservative Invasive P=0.07 Conservative P=NS Invasive Conservative Circ 109:584, 2004 CP CP
22 Short-Term Events Gusto IV ACS hs-ctnt neg/ctnt neg hs-ctnt pos/ctnt pos hs-ctnt pos/ctnt neg P<0.001 P=0.52 P<0.001 P=0.001 P=0.85 P=0.001 P<0.001 % 10 P=0.08 P= AHJ 160:224, 2010 Death at 1 yr Death/AMI at 30 days PCI at 30 days CP
23 DIAGNOSTIC PERFORMANCE OF THREE MODELS INCORPORATING hstnt AND ECG FINDINGS FOR EARLY EXCLUSION OF AMI Model Sensitivity Specificity PPV NPV (95% Cl) (95% Cl) (95%Cl) (95% Cl) A ( ) 30.1 ( ) 23.7 ( ) ( ) B 95.2 ( ) 69.4 ( ) 40.4 ( ) 98.5 ( ) C ( ) 66.4 ( ) 30.3 ( ) ( ) Model A: hstnt <3 ng/l and no ECG ischaemia; Model B: hstnt <14 ng/l and no ECG ischaemia; Model C: (hstnt <3 ng/l and no ECG ischaemia) OR (hstnt <14 ng/l and no ECG ischaemia and symptom onset <6h) Reference: Body CP
24 RULING OUT AMI 1. May require different criteria to do this early. 2. No data that sending people home with elevations and non ACS diagnoses is safe. 3. Using other markers will be associated with false positive elevations of that marker which will require some attention. CP
25 Post PCI and hsctn NO DATA CP
Defining rise and fall of cardiac troponin values
Defining rise and fall of cardiac troponin values Doable but Not Simple Allan S. Jaffe, MD.* Consultant - Cardiology & Laboratory Medicine Professor of Medicine Chair, CCLS Division, Department of Laboratory
Use of Biomarkers for Detection of Acute Myocardial Infarction
Use of Biomarkers for Detection of Acute Myocardial Infarction Allan S. Jaffe, MD.* Consultant - Cardiology & Laboratory Medicine Professor of Medicine Chair, CCLS Division, Department of Laboratory Medicine
10 Ways to Make the Use of High Sensitivity Cardiac Troponin Values Easier and Better
10 Ways to Make the Use of High Sensitivity Cardiac Troponin Values Easier and Better Allan S. Jaffe, MD.* Consultant - Cardiology & Laboratory Medicine Professor of Medicine Chair, CCLS Division, Department
Does serial troponin measurement help identify acute ischemia/ischemic events?
Does serial troponin measurement help identify acute ischemia/ischemic events? Allan S. Jaffe, MD.* Consultant - Cardiology & Laboratory Medicine Professor of Medicine and Laboratory Medicine & Pathology
Troponin when is an assay high sensitive?
Troponin when is an assay high sensitive? Professor P. O. Collinson MA MB BChir FRCPath FRCP edin MD FACB EurClin Chem Consultant Chemical Pathologist and Professor of Cardiovascular Biomarkers, Departments
TROPONINS HAVE THEY CHANGED YOUR
TROPONINS HAVE THEY CHANGED YOUR PRACTICE THIS WEEK? Harvey White John Neutze Scholar Green Lane Cardiovascular Service and Cardiovascular Research Unit Auckland City Hospital, Auckland, New Zealand Disclosure
Peri-operative Troponin Measurements - Pathophysiology and Prognosis
Peri-operative Troponin Measurements - Pathophysiology and Prognosis Allan S. Jaffe, MD.* Consultant - Cardiology & Laboratory Medicine Professor of Medicine Chair, CCLS Division, Department of Laboratory
High-Sensitivity Cardiac Troponin in Suspected ACS
15 th Annual Biomarkers in Heart Failure and Acute Coronary Syndromes STATE-OF-THE-ART High-Sensitivity Cardiac Troponin in Suspected ACS David A. Morrow, MD, MPH Director, Levine Cardiac Intensive Care
How will new high sensitive troponins affect the criteria?
How will new high sensitive troponins affect the criteria? Hugo A Katus MD Abteilung Innere Medizin III Kardiologie, Angiologie, Pulmologie Universitätsklinikum Heidelberg Even more sensitive: The new
BioRemarkable Symposium
BACC BioRemarkable Symposium Acute Myocardial infarction Stefan Blankenberg University Heart Center Hamburg London, September 7th, 2017 Universitätsklinikum Hamburg-Eppendorf Third Universal-Definition
Mario Plebani University-Hospital of Padova, Italy
Mario Plebani University-Hospital of Padova, Italy CK-MB mass assay CHF guidelines use BNP for rule out AST in AMI CK in AMI INH for CK-MB electrophoresis for CK and LD isoenzymes RIA for myoglobin WHO
Troponin Assessment. Does it Carry Clinical Message? Stefan Blankenberg. University Heart Center Hamburg
Biomarkers for Optimal Management of Heart Failure Troponin Assessment Does it Carry Clinical Message? Stefan Blankenberg University Heart Center Hamburg Congress of the European Society of Cardiology
Är dagens troponinmetoder tillräckligt känsliga?
Är dagens troponinmetoder tillräckligt känsliga? Per Venge, MD PhD Professor Department of Medical Sciences Uppsala University and Department of Clinical Chemistry and Pharmacology University Hospital
Impact of Troponin Performance on Patient Care
Impact of Troponin Performance on Patient Care Linda C, Rogers PhD, DABCC, FACB Agenda Introduction Diagnosis of MI Guidelines Troponin Assay differences Classification of troponin assays Guideline acceptable
Undetectable High Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction
Undetectable High Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction Nadia Bandstein, MD; Rickard Ljung, MD, PhD; Magnus Johansson, MD, PhD; Martin Holzmann,
Post-Procedural Myocardial Injury or Infarction
Post-Procedural Myocardial Injury or Infarction Hugo A Katus MD & Evangelos Giannitsis MD Abteilung Innere Medizin III Kardiologie, Angiologie, Pulmologie Universitätsklinikum Heidelberg Conflict of Interest:
IFCC Task Force on Clinical Applications of Cardiac Biomarkers (TF-CB) Report to the General Conference 2016 Madrid
IFCC Task Force on Clinical Applications of Cardiac Biomarkers (TF-CB) Report to the General Conference 2016 Madrid 1 CREATED By the EB in 2011, following to the Committee on Standardization of Cardiac
Congreso Nacional del Laboratorio Clínico 2016
Can biomarkers help us make a better use of cardiac imaging for myocardial ischaemia rule-out in the Emergency Department? Alessandro Sionis Director Acute and Intensive Cardiac Care Unit Hospital de la
Undetectable High Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction
Undetectable High Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction Nadia Bandstein, MD; Rickard Ljung, MD, PhD; Magnus Johansson, MD, PhD; Martin Holzmann,
Hit the road Jack! W. FRANK PEACOCK, MD, FACEP, FACC
Hit the road Jack! W. FRANK PEACOCK, MD, FACEP, FACC Visits 130,000,000 annually 10.4 M chest pain (8.0%) 4.1 M sent home non-cardiac 6.24 M suspected or actual cardiac 50,000 MIs 3.1 M non-cardiac (50%)
High Sensitivity Troponins. IT S TIME TO SAVE LIVES. Updates from the ESC 2015 Guidelines November 17th 2016 OPL CONGRESS Dr.
High Sensitivity Troponins. IT S TIME TO SAVE LIVES. Updates from the ESC 2015 Guidelines November 17th 2016 OPL CONGRESS Dr. Marcel El Achkar Chairperson of Laboratory department Nini Hospital Lecturer
Bertil Lindahl Akademiska sjukhuset Uppsala
Bertil Lindahl Akademiska sjukhuset Uppsala Kriterier för akut hjärtinfarkt Bevis på myokardskada/nekros: Konstaterad höjning och/eller sänkning av biomarkörer (företrädesvis troponin) med minst ett värde
High-sensitivity Troponin T Predicts Recurrent Cardiovascular Events in Patients with Stable Coronary Heart Disease: KAROLA Study 8 Year FU
ESC Congress 2011 Paris, France, August 27-31 KAROLA Session: Prevention: Are biomarkers worth their money? Abstract # 84698 High-sensitivity Troponin T Predicts Recurrent Cardiovascular Events in Patients
DIAGNOSTICS ASSESSMENT PROGRAMME
DIAGNOSTICS ASSESSMENT PROGRAMME Evidence overview Early rule out or diagnosis of acute myocardial infarction: High-sensitivity troponin tests (Elecsys troponin T high-sensitive, ARCHITECT STAT highsensitivity
Fifty shades of Troponin. Dr Liam Penny The Queens Hotel, Cheltenham 4 th October 2012
Fifty shades of Troponin Dr Liam Penny The Queens Hotel, Cheltenham 4 th October 2012 Plaque-fissure and intracoronary thrombus Courtesy Prof. MJ Davies Acute Coronary Syndromes Plaque-fissure and intracoronary
Chest pain and troponins on the acute take. J N Townend Queen Elizabeth Hospital Birmingham
Chest pain and troponins on the acute take J N Townend Queen Elizabeth Hospital Birmingham 3 rd Universal Definition of Myocardial Infarction Type 1: Spontaneous MI related to atherosclerotic plaque rupture
Cardiac Troponin Testing and Chest Pain Patients: Exploring the Shades of Gray
Cardiac Troponin Testing and Chest Pain Patients: Exploring the Shades of Gray Nichole Korpi-Steiner, PhD, DABCC, FACB University of North Carolina Chapel Hill, NC Learning Objectives Describe the acute
7/31/2018. Overview of Next Generation Cardiac Troponin T High Sensitivity. Disclosures. Course Objectives: high sensitive Troponin T assay
Overview of Next Generation Cardiac Troponin T High Sensitivity Arleen Francis Medical & Scientific Liaison Roche Diagnostics 1 Disclosures Arleen Francis is an employee of Roche Diagnostics and a member
Timing of angiography for high- risk ACS
Timing of angiography for high- risk ACS Christian Spaulding, MD, PhD, FESC, FACC Cardiology Department Cochin Hospital, Inserm U 970 Paris Descartes University Paris, France A very old story. The Interventional
Supplementary Online Content
Supplementary Online Content Rubini Giménez M, Twerenbold R, Boeddinghaus J, et al. Clinical effect of sex-specific cutoff values of high-sensitivity cardiac troponin T in suspected myocardial infarction.
The Clinical Laboratory Working with Physicians to Improve Patient Care
The Clinical Laboratory Working with Physicians to Improve Patient Care Michael A. Pesce, PhD Professor Emeritus Columbia University Medical Center Department of Pathology and Cell Biology Objectives Troponin
Waiting for High-Sensitivity POCT Cardiac Troponin Assays: Clinical and Analytical Needs I Have a Pain in My Chest That Hurts Very Bad
Waiting for High-Sensitivity POCT Cardiac Troponin Assays: Clinical and Analytical Needs I Have a Pain in My Chest That Hurts Very Bad Fred Apple PhD Hennepin County Medical Center University of Minnesota
CARDIOLOGY GRAND ROUNDS
CARDIOLOGY GRAND ROUNDS Presentation: Speaker: Date: Location: Troponin State of the Art: Past, Present and Future Yader Sandoval, MD Cardiovascular Disease Fellow Minneapolis Heart Institute at Abbott
Dolore Toracico e Livelli di Troponina non Misurabili
Dolore Toracico e Livelli di Troponina non Misurabili Andrea Fabbri Dipartimento di Emergenza Presidio Ospedaliero Morgagni Pierantoni Azienda USL Romagna Forlì andrea.fabbri@auslromagna.it Rapid Exclusion
The clinical performance of the novel POC Minicare ctni-assay. Per Venge, MD PhD Professor in Clinical Chemistry Uppsala University Uppsala, Sweden
The clinical performance of the novel POC Minicare ctni-assay Per Venge, MD PhD Professor in Clinical Chemistry Uppsala University Uppsala, Sweden Disclosure: Per Venge has received consultancy honoraria
New diagnostic markers for acute coronary syndromes
New diagnostic markers for acute coronary syndromes - Nye diagnostiske markørerer for akutt iskemisk hjertesykdom Bertil Lindahl, Professor Cardiology, Uppsala University and Uppsala Clinical Research
ACCESS hstni SCIENTIFIC LITERATURE
ACCESS hstni SCIENTIFIC LITERATURE 2017 2018 Table of contents Performance Evaluation of Access hstni A critical evaluation of the Beckman Coulter Access hstni: Analytical performance, reference interval
Post Operative Troponin Leak: David Smyth Christchurch New Zealand
Post Operative Troponin Leak: Does It Really Matter? David Smyth Christchurch New Zealand Life Was Simple Once Transmural Infarction Subendocardial Infarction But the Blood Tests Were n t Perfect Creatine
EDUCATIONAL COMMENTARY CARDIAC FUNCTION: BIOCHEMICAL MARKERS UPDATE
EDUCATIONAL COMMENTARY CARDIAC FUNCTION: BIOCHEMICAL MARKERS UPDATE Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE
Current Utilities of Cardiac Biomarker Testing at POC. June 24, 2010 Joe Pezzuto, MT (ASCP) Carolyn Kite, RN
Current Utilities of Cardiac Biomarker Testing at POC June 24, 2010 Joe Pezzuto, MT (ASCP) Carolyn Kite, RN 1. Discuss challenges associated with diagnosing Acute Coronary Syndromes (ACS) and Heart Failure
Troponin = 35. Objectives. Low Risk Chest Pain. Does this patient have ACS? Does this patient have ACS? Objectives
Objectives Low Risk Chest Pain Jeffrey Tabas, MD Professor of Emergency Medicine Office of CME UCSF School of Medicine Improve speed and accuracy in assessing patients with possible ACS! Avoid pitfalls
EDUCATIONAL COMMENTARY UNDERSTANDING THE BENEFITS AND CHALLENGES OF HIGH- SENSITIVITY TROPONIN TESTING IN CLINICAL AND PATHOLOGY SETTINGS
SENSITIVITY TROPONIN TESTING IN CLINICAL AND PATHOLOGY SETTINGS Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE
Adults With Diagnosed Diabetes
Adults With Diagnosed Diabetes 1990 No data available Less than 4% 4%-6% Above 6% Mokdad AH, et al. Diabetes Care. 2000;23(9):1278-1283. Adults With Diagnosed Diabetes 2000 4%-6% Above 6% Mokdad AH, et
Document Version Publisher s PDF, also known as Version of Record (includes final page, issue and volume numbers)
Variation of cardiac troponin I and T measured with sensitive assays in emergency department patients with noncardiac chest pain Scharnhorst, V.; Krasznai, K.; van 't Veer, M.; Michels, R.H. Published
High-Sensitive Troponin in the Evaluation of patients with Acute Coronary Syndrome (High-STEACS): a stepped-wedge cluster-randomised controlled trial
EUROPEAN SOCIETY OF CARDIOLOGY CONGRESS 2018 High-Sensitive Troponin in the Evaluation of patients with Acute Coronary Syndrome (High-STEACS): a stepped-wedge cluster-randomised controlled trial Professor
Low Risk Chest Pain. Objectives. Disclosure. Case 1. Jeffrey Tabas, MD Professor of Emergency Medicine Office of CME UCSF School of Medicine
Disclosure Low Risk Chest Pain No Financial Relationships to Disclose No significant investments or savings Unlimited Expenses Jeffrey Tabas, MD Professor of Emergency Medicine Office of CME UCSF School
Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a sensitive troponin I assay
Original Article Annals of Clinical Biochemistry 2015, Vol. 52(5) 543 549! The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalspermissions.nav DOI: 10.1177/0004563215576976 acb.sagepub.com
Acute Coronary Syndromes
High-sensitivity Troponins Difficult Friends in Acute Coronary Syndromes Roland Klingenberg, Christian M Matter, 2 Christophe Wyss, Danielle Hof, Arnold von Eckardstein and Thomas F Lüscher 6. Clinical
DIFFERENTIATING THE PATIENT WITH UNDIFFERENTIATED CHEST PAIN
DIFFERENTIATING THE PATIENT WITH UNDIFFERENTIATED CHEST PAIN Objectives Gain competence in evaluating chest pain Recognize features of moderate risk unstable angina Review initial management of UA and
EARLY DIAGNOSIS AND RISK STRATIFICATION IN PATIENTS WITH SYMPTOMS SUGGESTIVE OF ACUTE CORONARY SYNDROME
DEPARTMENT OF CLINICAL SCIENCE AND EDUCATION, SÖDERSJUKHUSET Karolinska Institutet, Stockholm, Sweden EARLY DIAGNOSIS AND RISK STRATIFICATION IN PATIENTS WITH SYMPTOMS SUGGESTIVE OF ACUTE CORONARY SYNDROME
Recognizing the High Risk NSTEMI Patient for Early Appropriate Therapy
Recognizing the High Risk NSTEMI Patient for Early Appropriate Therapy Learning Objectives Learn to recognize the high risk patient Discuss effective management of a high risk NSTEMI patient Review CCS
Improving the detection of myocardial infarction in women
Improving the detection of myocardial infarction in women British Cardiac Society Listening to the Female Voice 4 th June 2014 anoopsshah@gmail.com Dr Anoop Shah BHF Centre for Cardiovascular Sciences
High-Sensitivity Cardiac Troponin T Concentrations below the Limit of Detection to Exclude Acute Myocardial Infarction: A Prospective Evaluation
Clinical Chemistry 61:7 983 989 (2015) Proteomics and Protein Markers High-Sensitivity Cardiac Troponin T Concentrations below the Limit of Detection to Exclude Acute Myocardial Infarction: A Prospective
Title:Determinants of high sensitivity cardiac troponin T elevation in acute ischemic stroke
Author's response to reviews Title:Determinants of high sensitivity cardiac troponin T elevation in acute ischemic stroke Authors: Kashif W Faiz (kashif.faiz@medisin.uio.no) Bente Thommessen (bente.thommessen@ahus.no)
M/39 CC D. => peak CKMB (12 hr later) ng/ml T.chol/TG/HDL/LDL 180/150/48/102 mg/dl #
Acute Coronary Syndrome - Case Review - Young-Guk Ko, MD Yonsei Cardiovascular Center Yonsei University College of Medicine Case 1 M/39 #4306212 CC D : Severe squeezing chest pain : 4 hours, aggravated
Cindy L. Grines MD FACC FSCAI
Cindy L. Grines MD FACC FSCAI Hofstra Northwell School of Medicine Chair, Cardiology Academic Chief of Cardiology, Northwell Health North Shore University Hospital, Manhasset NY Multivessel Disease in
What can we learn from EQAs and audits for cardiac marker testing?
What can we learn from EQAs and audits for cardiac marker testing? Dr P. O. Collinson MA MB BChir FRCPath MD FACB Consultant Chemical Pathologist and Director of Clinical Blood Sciences, Head of Vascular
Acute Coronary Syndromes. January 9, 2013 Chris Chiles M.D. FACC
Acute Coronary Syndromes January 9, 2013 Chris Chiles M.D. FACC Disclosures None- not even a breakfast burrito from a drug company Hospitalizations in the U.S. Due to ACS Acute Coronary Syndromes* 1.57
Acute Coronary Syndrome. Sonny Achtchi, DO
Acute Coronary Syndrome Sonny Achtchi, DO Objectives Understand evidence based and practice based treatments for stabilization and initial management of ACS Become familiar with ACS risk stratification
Case Studies Using hsctn Assays. A Joint AACC ACC symposium Fred Apple Ph.D. Chris DeFlippi M.D. Allan S. Jaffe, M.D.
35105 - Case Studies Using hsctn Assays A Joint AACC ACC symposium Fred Apple Ph.D. Chris DeFlippi M.D. Allan S. Jaffe, M.D. Case Study: Defining Gender Specific 99 th Percentiles for High Sensitivity
hs-c Tn I high sensitivity troponin I <17 min
hs-c Tn I high sensitivity troponin I IFCC & ESC compliant 0/ h NSTEMI rule-out / rule-in algorithm POCT whole blood/plasma Results in < 7 minutes
Validation of an accelerated high-sensitivity troponin T assay protocol in an Australian cohort with chest pain
Elevation of cardiac troponin (ctn) levels is central to the definition of acute myocardial infarction (AMI). 1 Increasingly sensitive ctn assays offer the potential for AMI to be diagnosed earlier than
Belinda Green, Cardiologist, SDHB, 2016
Acute Coronary syndromes All STEMI ALL Non STEMI Unstable angina Belinda Green, Cardiologist, SDHB, 2016 Thrombus in proximal LAD Underlying pathophysiology Be very afraid for your patient Wellens
Risk Stratification of ACS Patients. Frans Van de Werf, MD, PhD University of Leuven, Belgium
Risk Stratification of ACS Patients Frans Van de Werf, MD, PhD University of Leuven, Belgium Which type of ACS patients are we talking about to day? 4/14/2011 STEMI and NSTEMI in the NRMI registry from
The Clinical Unmet need in the patient with Diabetes and ACS
The Clinical Unmet need in the patient with Diabetes and ACS Professor Kausik Ray (UK) BSc(hons), MBChB, MD, MPhil, FRCP (lon), FRCP (ed), FACC, FESC, FAHA Diabetes is a global public health challenge
ACUTE CORONARY SYNDROME PCI IN THE ELDERLY
ACUTE CORONARY SYNDROME PCI IN THE ELDERLY G.KARABELA MD.PhD ATHENS NAVAL HOSPITAL INTERVENTIONAL CARDIOLOGY DEPARTMENT NO CONFLICT OF INTEREST TO DECLAIRE Risk stratification in Αcute Coronary Syndrome.
TROPONIN POSITIVE 2/20/2015 WHAT DOES IT MEAN? When should a troponin level be obtained?
TROPONIN POSITIVE WHAT DOES IT MEAN? Frequently Asked Questions Regarding the Use of Troponin in the Clinical Setting What does an elevated troponin level mean? Elevated troponin is a sensitive and specific
Conference Paper Small Changes in Cardiac Troponin Levels Are Common in Patients with Myocardial Infarction: Diagnostic Implications
Conference Papers in Medicine, Article ID 583175, 5 pages http://dx.doi.org/10.1155/2013/583175 Conference Paper Small Changes in Cardiac Troponin Levels Are Common in Patients with Myocardial Infarction:
International Journal of Cardiology and Cardiovascular Research Vol. 4(2), pp , September, ISSN:
International Journal of Cardiology and Cardiovascular Research Vol. 4(2), pp. 072-078, September, 2018. www.premierpublishers.org, ISSN: 3102-9869 IJCCR Research Article Copeptin as a Novel Biomarker
Effective Health Care Program
Comparative Effectiveness Review Number 135 Effective Health Care Program Cardiac Troponins Used as Diagnostic and Prognostic Tests in Patients With Kidney Disease Executive Summary Background Cardiac
TYPE II MI. KC ACDIS LOCAL CHAPTER March 8, 2016
TYPE II MI KC ACDIS LOCAL CHAPTER March 8, 2016 TYPE 2 MI DEFINITION: Acute coronary syndrome (ACS) encompasses a continuum of myocardial ischemia and infarction, which can make the diagnostic and coding
Ticagrelor compared with clopidogrel in patients with acute coronary syndromes the PLATO trial
compared with clopidogrel in patients with acute coronary syndromes the PLATO trial August 30, 2009 at 08.00 CET PLATO background In NSTE-ACS and STEMI, current guidelines recommend 12 months aspirin and
RESPONSES TO COMMENTS ON: Recommendations for Use of Point-of-Care (POC) Troponin Assays in Assessment of Acute Coronary Syndrome
RESPONSES TO COMMENTS ON: Recommendations for Use of Point-of-Care (POC) Troponin Assays in Assessment of Acute Coronary Syndrome Page 1 Responses were received from: 1. Chemical Pathology Clinical Stream,
FFR-guided Complete vs. Culprit Only Revascularization in AMI Patients Ki Hong Choi, MD On Behalf of FRAME-AMI Investigators
FFR-guided Complete vs. Culprit Only Revascularization in AMI Patients Ki Hong Choi, MD On Behalf of FRAME-AMI Investigators Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of
Imaging ischemic heart disease: role of SPECT and PET. Focus on Patients with Known CAD
Imaging ischemic heart disease: role of SPECT and PET. Focus on Patients with Known CAD Hein J. Verberne Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands International Conference
The patient with 30 min chest pain presenting at the ER two hours after onset of symptoms. Professor Christian Mueller
The patient with 30 min chest pain presenting at the ER two hours after onset of symptoms Professor Christian Mueller Disclosures Swiss National Science Foundation.... Research support / travel support
Impact of Aging on High-sensitivity Cardiac Troponin T in Patients Suspected of Acute Myocardial Infarction
doi: 10.2169/internalmedicine.8510-16 http://internmed.jp ORIGINAL ARTICLE Impact of Aging on High-sensitivity Cardiac Troponin T in Patients Suspected of Acute Myocardial Infarction Taro Ichise, Hayato
9/18/2017. Disclosures. Cardiac Troponin: ER Utilization and the Next Generation
Disclosures Cardiac Troponin: ER Utilization and the Next Generation Joshua Soldo is an employee of Roche Diagnostics within the division of Medical Scientific Affairs. Data presented is intended for purely
Update on Antithrombotic Therapy in Acute Coronary Syndrome
Update on Antithrombotic Therapy in Acute Coronary Syndrome Laura Tsang November 13, 2006 Objectives: By the end of this session, you should understand: The role of antithrombotics in ACS Their mechanisms
J-curve Revisited. An Analysis of Blood Pressure and Cardiovascular Events in the Treating to New Targets (TNT) Trial
J-curve Revisited An Analysis of Blood Pressure and Cardiovascular Events in the Treating to New Targets (TNT) Trial Sripal Bangalore, MD, MHA, Franz H Messerli, MD, Chuan-Chuan Wun, PhD, Andrea L. Zuckerman,
Prasugrel vs. Ticagrelor in ACS/PCI Which one to choose? V. Voudris MD FESC FACC 2 nd Cardiology Division Onassis Cardiac Surgery Center
Prasugrel vs. Ticagrelor in ACS/PCI Which one to choose? V. Voudris MD FESC FACC 2 nd Cardiology Division Onassis Cardiac Surgery Center Hospitalizations in the U.S. Due to ACS Acute Coronary Syndromes
Low concentrations of high-sensitivity troponin T at presentation to the
Title Page Low concentrations of high-sensitivity troponin T at presentation to the Emergency Department. Running head: Early rule-out using high-sensitivity troponin T Article Type: Letter to the Editor
(ClinicalTrials.gov ID: NCT ) Title: The Italian Elderly ACS Study Author: Stefano Savonitto. Date: 29 August 2011 Meeting: ESC congress, Paris
Early aggressive versus initially conservative strategy in elderly patients with non-st- elevation acute coronary syndrome: the Italian randomised trial (ClinicalTrials.gov ID: NCT00510185) Stefano Savonitto,
REVISED MI DEFINITIONS IMPLICATIONS FOR CLINICAL TRIALS. Maarten L Simoons Thoraxcenter - Erasmus MC Rotterdam - The Netherlands
REVISED MI DEFINITIONS IMPLICATIONS FOR CLINICAL TRIALS Maarten L Simoons Thoraxcenter - Erasmus MC Rotterdam - The Netherlands TRITON Prasugrel ACS + PCI n = 13,608 moderate / high risk ACS, all PCI p
Evaluating Clinical Risk and Guiding management with SPECT Imaging
Evaluating Clinical Risk and Guiding management with SPECT Imaging Raffaele Giubbini Chair and Nuclear Medicine Unit University & Spedali Civili Brescia- Italy U.S. Congressional Budget Office. Technological
Supplementary Online Content
Supplementary Online Content McEvoy JW, Chen Y, Ndumele CE, et al. Six-year change in high-sensitivity cardiac troponin T and risk of subsequent coronary heart disease, heart failure, and death. JAMA Cardiol.
An update on the management of UA / NSTEMI. Michael H. Crawford, MD
An update on the management of UA / NSTEMI Michael H. Crawford, MD New ACC/AHA Guidelines 2007 What s s new in the last 5 years CT imaging advances Ascendancy of troponin and BNP Clarification of ACEI/ARB
Characterization of Types and Sizes of Myocardial Infarction Reduced with Evolocumab in FOURIER
Characterization of Types and Sizes of Myocardial Infarction Reduced with Evolocumab in FOURIER Stephen D Wiviott, Robert P Giugliano, David A Morrow, Gaetano M De Ferrari, Basil S Lewis, Kurt Huber, Julia
10 Steps to Managing Non-ST Elevation ACS
Pathophysiology of Acute Coronary Syndromes and Potential Pharmacologic Interventions Acute Coronary Syndrome 4. Downstream from thrombus myocardial ischemia/necrosis (Beta-blockers, Nitrates etc) 3. Activation
Over-diagnosis in pathology testing and the impact on patients
Over-diagnosis in pathology testing and the impact on patients Sally Lord MBBS, MS(Epi) School of Medicine, The University of Notre Dame NHMRC Clinical Trials Centre, The University of Sydney Landmark
Fasting or non fasting?
Vascular harmony Robert Chilton Professor of Medicine University of Texas Health Science Center Director of Cardiac Catheterization labs Director of clinical proteomics Which is best to measure Lower continues
Assays Pros and Cons AACB 2013 GOLD COAST QUEENSLAND AUSTRALIA
Highly Sensitive Versus Sensitive Troponin Assays Pros and Cons AACB 2013 GOLD COAST QUEENSLAND AUSTRALIA Robert H. Christenson, Ph.D., DABCC, FACB 2013 AACC President Professor of Pathology Professor
Cardiac Biomarkers in Acute Chest Pain
Cardiac Biomarkers in Acute Chest Pain Dr. K. Shanthi Naidu, Prof & HOD & Dept of Biochemistry, CARE Hospitals, Banjara Hills, Hyderabad. Dr Maddury Jyotsna Prof & HOU-IV, Dept of Cardiology, Nizam s institute
Chest Pain. Dr Robert Huggett Consultant Cardiologist
Chest Pain Dr Robert Huggett Consultant Cardiologist Outline Diagnosis of cardiac chest pain 2016 NICE update on stable chest pain Assessment of unstable chest pain/acs and MI definition Scope of the
CVD risk assessment using risk scores in primary and secondary prevention
CVD risk assessment using risk scores in primary and secondary prevention Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil Disclosure Honoraria for consulting and speaker activities
Cardiology Department Coimbra Hospital and Medical School Portugal
Quantitative troponin elevation provide incremental prognostic value beyond comprehensive risk stratification in patients with acute coronary syndromes. Rui Baptista, Elisabete Jorge, Hélia Martins, Fátima
Clinical Considerations of High Sensitivity Troponins
Clinical Considerations of High Sensitivity Troponins Copyright 2018 by. Learning Objectives: 1. Describe high-sensitivity troponin clinical utility in the primary diagnosis of ACS/AMI in conjunction with
Chest pain management. Ruvin Gabriel and Niels van Pelt August 2011
Chest pain management Ruvin Gabriel and Niels van Pelt August 2011 Introduction Initial assessment Case 1 Case 2 and 3 Comparison of various diagnostic techniques Summary 1-2 % of GP consultations are
Recent community campaigns on
Availability of highly sensitive troponin assays and acute coronary syndrome care: insights from the SNAPSHOT registry Use of hs troponin testing of patients hospitalised with possible ACS was associated
CLINICAL GUIDANCE FRAMEWORKS
IMPROVING CARE PROCESSES FOR PATIENTS WITH POSSIBLE SUSPECTED ACUTE CORONARY SYNDROME (ICARE-ACS): A NATIONAL IMPLEMENTATION TRIAL OF A CLINICAL GUIDANCE FRAMEWORK S Aldous; on behalf of the IcareACS team