Risk of myocardial infarction at specific troponin T levels using the parameter predictive value among lookalikes (PAL)
2017 (English)In: Clinical Biochemistry, ISSN 0009-9120, E-ISSN 1873-2933, Vol. 50, no 1-2Article in journal (Refereed) Published
Background: Myocardial infarction is more likely if the heart damage biomarker cardiac troponin T (cTnT) is elevated in a blood sample, indicating that cardiac damage has occurred. No method allows the clinician to estimate the risk of myocardial infarction at a specific cTnT level in a given patient. Methods: Predictive value among lookalikes (PAL) uses pre-test prevalence, sensitivity and specificity at adjacent cTnT limits based on percentiles. PAL is the pre-test prevalence-adjusted probability of disease between two adjacent cTnT limits. If a chest pain patients cTnT level is between these limits, the risk of myocardial infarction can be estimated. Results: The PAL based on percentiles had an acceptable sampling error when using 100 bootstrapped data of 18 different biomarkers from 38,945 authentic lab measurements. A PAL analysis of an emergency room cohort (n = 11,020) revealed that the diagnostic precision of a high-sensitive cTnT assay was similar among chest pain patients at different ages. The higher incidence of false positive results due to non-specific increases in cTnT in the high-age group was counterbalanced by a higher pre-test prevalence of myocardial infarction among older patients, a finding that was missed when using a conventional ROC plot analysis. Conclusions: The PAL was able to calculate the risk of myocardial infarction at specific cTnT levels and could complement decision limits. 2016 The Authors. The Canadian Society of Clinical Chemists. Published by Elsevier Inc.
Place, publisher, year, edition, pages
PERGAMON-ELSEVIER SCIENCE LTD , 2017. Vol. 50, no 1-2
Cardiac and Cardiovascular Systems
IdentifiersURN: urn:nbn:se:liu:diva-134488DOI: 10.1016/j.clinbibchem.2016.09.012ISI: 000391648400002OAI: oai:DiVA.org:liu-134488DiVA: diva2:1074416
Funding Agencies|Swedish Cancer Society; Swedish Research Council; Swedish Pain Foundation (SSF); Assar Gabrielsson Cancer Research Foundation; LUA/ALF at the Sahlgrenska University Hospital; County Council of Ostergotland2017-02-152017-02-152017-02-15