A Rational Adoption of the High Sensitive Assay for Cardiac Troponin I in Diagnostic Routine

Table 5

Details on nine cases with initial diagnosis in the Emergency Department discrepant with cardiac troponin I results. The final diagnosis (last column on the right) was consistent with an acute coronary syndrome in seven of them. The last case is described in more detail on Figure 7. ED = emergency department; n.a. = not available; APT = atrial paroxysmal tachycardia; cTnI and hs-cTnI: assay results by contemporary and high sensitive assays for cardiac troponin I, expressed in ng/L; STEMI = myocardial infarction with ST elevation; NSTEMI = myocardial infarction without ST elevation; APE = acute pulmonary edema.

Sex	Age	Initial diagnosis (ED)	TnI T0	hsTnI T0	TnI T3	hsTnI T3	TnI T6	hsTnI T6	TnI increase; from T0	Final diagnosis
F	91	Acute pulmonary edema	371	409	n.a.	n.a.	1366	1523	172%	NSTEMI (exitus)
M	81	Acute pulmonary edema	213	117	n.a.	n.a.	8760	11,621	9699%	APE + STEMI
M	56	Acute pericarditis	222	208	842	991	n.a.	n.a.	376%	NSTEMI + multiple; pathologies
M	64	Acute pulmonary edema	42	32	123	111	121	112	147%	APE + NSTEMI
F	75	Anaphylactic shock	39	30	134	104	n.a.	n.a.	247%	NSTEMI (referred to; other hospitals)
F	88	APT	61	63	236	n.a.	346	334	283%	NSTEMI + APT
F	80	Acute pulmonary edema	51	45	n.a.	n.a.	137	123	73%	APE + NSTEMI
M	89	Lipothymia	40	14	62	35	n.a.	n.a.	93%	No ACS—pacemaker; implanted
F	91	Acute respiratory failure	20	21	43	46	n.a.	n.a.	116%	Acute respiratory failure