Article Figures & Data
Figures
- Figure 1.
Receiver operating characteristic (ROC) curve comparison for mortality. The univariate ROC curves for initial, change, and maximum troponin are overlaid. The curves graph the true positive (sensitivity) rate by the false negative rate (1-specificity); curves closer to the top right corner indicate better diagnostic performance. Compared to initial and delta troponin values (area under the curve [AUC] 0.65 and 0.61, respectively), maximum troponin (AUC 0.68) best predicts mortality.
- Figure 2.
Receiver operating characteristic (ROC) curve comparison for acute myocardial infarction diagnosis. The univariate ROC curves for initial, change, and maximum troponin are overlaid. The curves graph the true positive (sensitivity) rate by the false negative rate (1-specificity); curves closer to the top right corner indicate better diagnostic performance. Compared to initial and delta troponin values (area under the curve [AUC] 0.86 and 0.89, respectively), maximum troponin (AUC 0.94) best predicts acute myocardial infarction.
Tables
- Table 1.
Baseline Characteristics of Patients With at Least One Troponin Value and Age ≥40 Years
Variable Patient Population, n=30,173 Demographics Age, years, median (range) 70 (40-104) Sex Male 14,497 (48.05) Female 15,676 (51.95) Risk factors Smoker 6,069 (20.11) Hypertension 23,780 (78.81) Hyperlipidemia 16,464 (54.57) Type 1 diabetes mellitus 199 (0.66) Type 2 diabetes mellitus 11,229 (37.22) History Coronary artery disease 9,079 (30.09) Chronic kidney disease 6,011 (19.92) Chronic obstructive pulmonary disease 5,899 (19.55) Prior cerebral vascular accident 724 (2.40) Prior myocardial infarction 2,531 (8.39) Note: Data are presented as n (%) unless otherwise noted.
Troponin Level n 25th Percentile Median (range) 75th Percentile Initial troponin 22,384a 0.01 0.02 (0-360.92) 0.07 Maximum troponin 23,965 0.01 0.03 (0-647.54) 0.10 Change in troponin (maximum – minimum) 23,965 0.00 0.00 (0-647.54) 0.03 ↵aIn our analysis, an initial troponin value that was below detectable limit was considered missing; hence, the n is 1,581 less than the sample size for the maximum troponin and change in troponin.
- Table 3.
Logistic Regression With the Firth Penalized Likelihood Approach for Initial, Maximum, and Change in Troponin on Mortality
Troponin Level Odds Ratio 95% CI P Value AUC 95% CI Initial troponin 1.009 1.004-1.013 0.0002 0.6547 0.6334-0.6760 Maximum troponin 1.007 1.005-1.009 <0.0001 0.6782 0.6576-0.6989 Change in troponin (maximum – minimum) 1.007 1.005-1.009 <0.0001 0.6113 0.5892-0.6333 Note: Logistic regression with the Firth penalized likelihood approach was performed to assess the predictive ability of initial, maximum, and change in troponin level on death at index admission. The P value for troponin value indicates statistical significance for predicting mortality.
AUC, area under the receiver operating characteristic curve.
- Table 4.
Receiver Operating Characteristic (ROC) Curve Comparisons for Initial, Maximum, and Change in Troponin on Mortality
Troponin Comparison Difference in ROC Curves 95% Wald Confidence Limits P Value Maximum vs initial 0.0235 0.0119 to 0.0352 <0.0001 Change vs initial –0.0434 –0.0670 to –0.0198 0.0003 Change vs maximum –0.0670 –0.0839 to –0.0500 <0.0001 Note: Nonparametric comparisons of area under the ROC curves were performed to test for significant differences in the ability of each univariate model to predict mortality. The maximum troponin value model predicts death significantly better than the initial troponin model and the change in troponin model.
- Table 5.
Logistic Regression With the Firth Penalized Likelihood Approach for Initial, Maximum, and Change in Troponin on Acute Myocardial Infarction
Troponin Level Odds Ratio 95% CI P Value AUC 95% CI Initial troponin 1.074 1.063-1.086 <0.0001 0.8562 0.8454-0.8670 Maximum troponin 1.031 1.028-1.034 <0.0001 0.9401 0.9353-0.9449 Change in troponin (maximum – minimum) 1.031 1.027-1.034 <0.0001 0.8939 0.8848-0.9030 Note: Logistic regression with the Firth penalized likelihood approach was performed to assess the predictive ability of initial, maximum, and the change in troponin level on a primary diagnosis of acute myocardial infarction vs any other diagnosis. The P value for troponin value indicates statistical significance for predicting acute myocardial infarction.
AUC, area under the receiver operating characteristic curve.
- Table 6.
Receiver Operating Characteristic (ROC) Curve Comparisons for Initial, Maximum, and Change in Troponin on Acute Myocardial Infarction
Troponin Comparison Difference in ROC Curves 95% Wald Confidence Limits P Value Maximum vs initial 0.0839 0.0737 to 0.0941 <0.0001 Change vs initial 0.0377 0.0237 to 0.0517 <0.0001 Change vs maximum –0.0462 –0.0540 to –0.0385 <0.0001 Note: Nonparametric comparisons of area under the ROC curves were performed to test for significant differences in the ability of each univariate model to predict acute myocardial infarction. The maximum troponin value model predicts acute myocardial infarction significantly better than the initial troponin model and the change in troponin model.
- Table 7.
Multinominal Logistic Regression for Initial, Maximum, and Change in Troponin to Predict Acute Myocardial Infarction (AMI) vs Non-AMI Cardiac, Pulmonary, Sepsis, and Other Diagnoses
Comparison Troponin Level Odds Ratio 95% CI P Value AMI vs non-AMI cardiac Initial 1.042 1.033-1.053 <0.0001 Maximum 1.018 1.015-1.020 <0.0001 Change 1.018 1.015-1.020 <0.0001 AMI vs pulmonary Initial 2.364 1.852-3.165 <0.0001 Maximum 1.468 1.330-1.653 <0.0001 Change 1.471 1.314-1.692 <0.0001 AMI vs sepsis Initial 1.063 1.047-1.082 <0.0001 Maximum 1.035 1.029-1.042 <0.0001 Change 1.035 1.028-1.042 <0.0001 AMI vs other diagnoses Initial 1.335 1.285-1.391 <0.0001 Maximum 1.122 1.109-1.136 <0.0001 Change 1.118 1.103-1.133 <0.0001 Troponin Level C-Statistic Initial 0.6061 Maximum 0.6391 Change 0.6271 Note: The multinominal areas under the curve show that the maximum troponin level is most predictive of acute myocardial infarction vs other diagnoses.
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