The ratio of N-terminal pro-brain natriuretic peptide to high sensitivity cardiac troponin to distinguish type 1 from type 2 acute myocardial infarction
Gibbs J, McCord J, Hudson M, Moyer M, Jacobsen G, Trupp R, Nowak R. The ratio of N-terminal pro-brain natriuretic peptide to high sensitivity cardiac troponin to distinguish type 1 from type 2 acute myocardial infarction. J Am Coll Cardiol. 2018;71(11)
J Am Coll Cardiol
Background: Differentiation between type 1 and type 2acute myocardial infarction (AMI) is a common clinical challenge. Objective criteria to distinguish them are lacking, and at times these patients are treated inappropriately. Methods: In a single center, we prospectively enrolled 569 patients evaluated for possible AMI in the emergency department from 2013 to 2015. Diagnosis of type 1 and type2 AMI was adjudicated by 2 independent physicians in accordance with the universal definition of AMI using all available clinical information over 30 days and required cardiac troponin-I > 0.04ng/mL (Siemens Ultra). Levels of N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) and High Sensitivity Cardiac Troponin-T (hs-cTnT) (Roche Diagnostics) were obtained at time 0, 1 hour and 3 hours. Results: There were 44 (7.7%) patients that had an AMI (26 type 1 and 18 type 2). The NT-pro-BNP levels and the ratioof NT-proBNP to hs-cTnT were signifcantly higher in those with type 2 AMI. Patients with type 1 AMI tended to have higher hs-cTnT, but this was not statistically signifcant. Receiver operator characteristic curve analysis yielded an optimal cut-point for the ratio of 14.8 for differentiating between AMI type (area under the curve of 0.765). Conclusion: The measurement of the ratio of NT-proBNP tohs-cTnT may help distinguish type 1 AMI from type 2 AMI at presentation. This may help guide therapy when thediagnosis is uncertain.