Can we monitor heart attack in the troponin era: evidence from a population-based cohort study

Sanfilippo, Frank M., Hobbs, Michael S., Knuiman, Matthew W., Ridout, Stephen C., Bradshaw, Pamela J., Finn, Judith C., Rankin, Jamie M., Sprivulis, Peter C. and Hung, Joseph (2011) Can we monitor heart attack in the troponin era: evidence from a population-based cohort study. BMC Cardiovascular Disorders, 11 . doi:10.1186/1471-2261-11-35

Author Sanfilippo, Frank M.
Hobbs, Michael S.
Knuiman, Matthew W.
Ridout, Stephen C.
Bradshaw, Pamela J.
Finn, Judith C.
Rankin, Jamie M.
Sprivulis, Peter C.
Hung, Joseph
Title Can we monitor heart attack in the troponin era: evidence from a population-based cohort study
Journal name BMC Cardiovascular Disorders   Check publisher's open access policy
ISSN 1471-2261
Publication date 2011-06-24
Sub-type Article (original research)
DOI 10.1186/1471-2261-11-35
Open Access Status DOI
Volume 11
Total pages 8
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Background: Troponins (highly sensitive biomarkers of myocardial damage) increase counts of myocardial infarction (MI) in clinical practice, but their impact on trends in admission rates for MI in National statistics is uncertain.

Methods: Cases coded as MI or other cardiac diagnoses in the Hospital Morbidity Data Collection (MI-HMDC) in Western Australia in 1998 and 2003 were classified using revised criteria for MI developed by an International panel convened by the American Heart Association (AHA criteria) using information on symptoms, ECGs and cardiac biomarkers abstracted from samples of medical notes. Age-sex standardized rates of MI-HMDC were compared with rates of MI based on AHA criteria including troponins (MI-AHA) or traditional biomarkers only (MI-AHAck).

Results: Between 1998 and 2003, rates of MI-HMDC decreased by 3.5% whereas rates of MI-AHA increased by 17%, a difference largely due to increased false-negative cases in the HMDC associated with marked increased use of troponin tests in cardiac admissions generally, and progressively lower test thresholds. In contrast, rates of MI-AHAck declined by 18%.

Conclusions: Increasing misclassification of MI-AHA by the HMDC may be due to reluctance by clinicians to diagnose MI based on relatively small increases in troponin levels. These influences are likely to continue. Monitoring MI using AHA criteria will require calibration of commercially available troponin tests and agreement on lower diagnostic thresholds for epidemiological studies. Declining rates of MI-AHAck are consistent with long-standing trends in MI in Western Australia, suggesting that neither MI-HMDC nor MI-AHA reflect the true underlying population trends in MI.  
Keyword AHA Medical/Scientific Statements
Cardiac biomarkers
Myocardial infarction
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Article number 35.

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Nursing, Midwifery and Social Work Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 18 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 16 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Thu, 17 Jul 2014, 09:17:45 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work