Identification of acute myocardial infarction in elderly patients using optimized highly sensitive troponin I thresholds
Beatrice von Jeinsen , MD, Christoph Liebetrau , MD, Lars Palapies , MSc, Stergios Tzikas , MD, Tanja Zeller , PhD, Christoph Bickel , MD,  show all
Received 01 Nov 2018, Accepted 05 Apr 2019, Accepted author version posted online: 03 Jun 2019
Download citation  https://doi.org/10.1080/1354750X.2019.1606276 

Select Language​▼
Translator disclaimer
 Accepted author version
Abstract
Purpose: Established diagnostic thresholds for high-sensitivity cardiac troponins (hs-cTn) might not apply for elderly patients as they are elevated irrespective of the presence of an acute myocardial infarction (AMI). Aim of the present study was to investigate hs-cTnI in elderly patients with suspected AMI and to calculate optimized diagnostic cut-offs.

Material and Methods: Data from a prospective multi-center study and from a second independent prospective single-center cohort study was analyzed. 2903 patients were eligible for further analysis. Patients >70 years were classified as elderly. hs-cTnI was measured upon admission.

Results: 34.7% of 2903 patients were classified as elderly. 22.5% of elderly patients were finally diagnosed with AMI. Elderly patients had higher hs-cTnI levels at admission irrespective of the final diagnosis (p < 0.001). According to the AUROC, hs-cTnI was a strong marker for detection of AMI in elderly patients. Application of the 99th percentile cut-offs showed a substantially lower specificity in elderly. By using optimized thresholds, specificity was improved to levels as in younger patients in both cohorts but accompanied with a decrease in sensitivity.

Conclusions: hs-cTnI levels have a lower specificity for detecting AMI in elderly patients. This lower specificity can be improved by using hs-cTnI thresholds optimized for elderly patients.

Keywords: Acute myocardial infarction, Troponin, Biomarkers, Elderly, Age