Value of the initial troponin T level in the diagnosis of acute myocardial infarction - a probability model / Roberto V. Anastacio , Saturnino P. Javier

Contributor(s): Subject(s): Abstract: Troponin T is increasingly being recognized as a reliable marker of myocardial necrosis in myocardial infarction (MI). To assess the value of a single initial troponin T level in the diagnosis of acute MI, we prospectively analyzed the initial values obtained in 71 patients (47 males and 26 females, mean age 58 years) admitted for possible acute MI. Fourteen patients (19%) satisfied the WHO criteria for acute MI. In those with a final diagnosis of acute MI, 10 (71%) patients had initial elevation (1.7 +/- 2.2 ug/ml) while 4 (29%) had levels below the normal cut-ff value of 0-0.1 ug/ml. By analysis of maximum likelihood estimates based on these initial values, we constructed a probability model to predict the likelihood of the diagnosis of acute MI. Using this model, an initial level of 0.4 ug/ml has a 25% chance of diagnosing acute MI However, an initial value of 0.8 ug/ml (twice) has a 50% probability. Furthermore, a value of 1.0 ug/ml has close to 75% likelihood of correctly diagnosing acute MI. In conclusion, the magnitude of the initial rise in the level of troponin T correlates strongly with the likelihood of diagnosing acute MI.
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Troponin T is increasingly being recognized as a reliable marker of myocardial necrosis in myocardial infarction (MI). To assess the value of a single initial troponin T level in the diagnosis of acute MI, we prospectively analyzed the initial values obtained in 71 patients (47 males and 26 females, mean age 58 years) admitted for possible acute MI. Fourteen patients (19%) satisfied the WHO criteria for acute MI. In those with a final diagnosis of acute MI, 10 (71%) patients had initial elevation (1.7 +/- 2.2 ug/ml) while 4 (29%) had levels below the normal cut-ff value of 0-0.1 ug/ml. By analysis of maximum likelihood estimates based on these initial values, we constructed a probability model to predict the likelihood of the diagnosis of acute MI. Using this model, an initial level of 0.4 ug/ml has a 25% chance of diagnosing acute MI However, an initial value of 0.8 ug/ml (twice) has a 50% probability. Furthermore, a value of 1.0 ug/ml has close to 75% likelihood of correctly diagnosing acute MI. In conclusion, the magnitude of the initial rise in the level of troponin T correlates strongly with the likelihood of diagnosing acute MI.



Makati Medical Center Proceedings, 1999 (13) pages 28-34

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