PLEASE SAVE A COPY OF THIS FLIER AS YOUR CERTIFICATE OF ATTENDANCE CARDIOLOGY GRAND ROUNDS Presentation: Troponin State of the Art: Past, Present and Future Speaker: Yader Sandoval, MD Cardiovascular Disease Fellow Minneapolis Heart Institute® at Abbott Northwestern Hospital & Hennepin County Medical Center Research Associate Cardiac Biomarkers Trials Laboratory, Minneapolis Medical Research Foundation Date: Monday, April 27, 2015, 7:00 – 8:00 AM Location: ANW Education Building, Watson Room OBJECTIVES At the completion of this activity, the participants should be able to: 1. Recognize the analytical characteristics of cardiac troponin assays. 2. Describe the differences between contemporary and high-sensitivity cardiac troponin assays. 3. Describe the relation between cardiac troponin and the Universal Definition of MI with an emphasis on type 1 and 2 myocardial infarction. 4. Explain future directions of cardiac troponin. ACCREDITATION Physicians: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Allina Health and Minneapolis Heart Institute Foundation. Allina Health is accredited by the ACCME to provide continuing medical education for physicians. Allina Health designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit TM . Physicians should only claim credit commensurate with the extent of their participation in the activity. Nurses: This activity has been designed to meet the Minnesota Board of Nursing continuing education requirements for 1.2 hours of credit. However, the nurse is responsible for determining whether this activity meets the requirements for acceptable continuing education. Others: Individuals representing other professional disciplines may submit course materials to their respective professional associations for 1.0 hours of continuing education credit. DISCLOSURE STATEMENTS Speaker: Dr. Sandoval has declared he does not have any conflicts of interest to disclose. Planning Committee: Dr. Michael Miedema, and Eva Zewdie have declared that they do not have any conflicts of interest associated with the planning of this activity. Dr. Robert Schwartz declared the following relationships - stockholder: Cardiomind, Interface Biologics, Aritech, DSI/Transoma, InstyMeds, Intervalve, Medtronic, Osprey Medical, Stout Medical, Tricardia LLC, CoAptus Inc, Augustine Biomedical; scientific advisory board: Abbott Laboratories, Boston Scientific, MEDRAD Inc, Thomas, McNerney & Partners, Cardiomind, Interface Biologics; options: BackBeat Medical, BioHeart, CHF Solutions; speakers bureau: Vital Images; consultant: Edwards LifeSciences.
35
Embed
CARDIOLOGY GRAND ROUNDS · 1. Recognize the analytical characteristics of cardiac troponin assays. 2. Describe the differences between contemporary and high-sensitivity cardiac troponin
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
PLEASE SAVE A COPY OF THIS FLIER AS YOUR CERTIFICATE OF ATTENDANCE
C A R D I O L O G Y G R A N D R O U N D S Presentation: Troponin State of the Art: Past, Present and Future
Speaker: Yader Sandoval, MD Cardiovascular Disease Fellow Minneapolis Heart Institute® at Abbott Northwestern Hospital & Hennepin County Medical Center Research Associate Cardiac Biomarkers Trials Laboratory, Minneapolis Medical Research Foundation
Date: Monday, April 27, 2015, 7:00 – 8:00 AM Location: ANW Education Building, Watson Room
OBJECTIVES At the completion of this activity, the participants should be able to: 1. Recognize the analytical characteristics of cardiac troponin assays. 2. Describe the differences between contemporary and high-sensitivity cardiac troponin assays. 3. Describe the relation between cardiac troponin and the Universal Definition of MI with an emphasis on type 1 and 2
myocardial infarction. 4. Explain future directions of cardiac troponin.
ACCREDITATION Physicians: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Allina Health and Minneapolis Heart Institute Foundation. Allina Health is accredited by the ACCME to provide continuing medical education for physicians.
Allina Health designates this live activity for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Nurses: This activity has been designed to meet the Minnesota Board of Nursing continuing education requirements for 1.2 hours of credit. However, the nurse is responsible for determining whether this activity meets the requirements for acceptable continuing education.
Others: Individuals representing other professional disciplines may submit course materials to their respective professional associations for 1.0 hours of continuing education credit. DISCLOSURE STATEMENTS Speaker: Dr. Sandoval has declared he does not have any conflicts of interest to disclose.
Planning Committee: Dr. Michael Miedema, and Eva Zewdie have declared that they do not have any conflicts of interest associated with the planning of this activity. Dr. Robert Schwartz declared the following relationships - stockholder: Cardiomind, Interface Biologics, Aritech, DSI/Transoma, InstyMeds, Intervalve, Medtronic, Osprey Medical, Stout Medical, Tricardia LLC, CoAptus Inc, Augustine Biomedical; scientific advisory board: Abbott Laboratories, Boston Scientific, MEDRAD Inc, Thomas, McNerney & Partners, Cardiomind, Interface Biologics; options: BackBeat Medical, BioHeart, CHF Solutions; speakers bureau: Vital Images; consultant: Edwards LifeSciences.
SUBSTANTIAL VARIABILITY BETWEEN LABORATORIES IN TROPONIN DECISION LEVEL FOR DIAGNOSIS OF MYOCARDIAL INFARCTION AND ASSAY 99TH PERCENTILE: FINDINGS FROM THE INTERNATIONAL STUDY OF COMPARATIVE HEALTH EFFECTIVENESS WITH MEDICAL AND INVASIVE APPROACHES (ISCHEMIA) TRIAL
J Am Coll Cardiol. 2014;63(12_S). doi:10.1016/S0735-1097(14)61881-7
Significant variability exists in the cTn MI decision level used by hospital laboratories relative to the assay cTn 99th percentile.
Only one-third of labs follow the Third Universal Definition of MI. These data have important implications for the diagnosis of MI in clinical practice and adjudicating MI
endpoints in clinical trials.
Troponin Assays: Understanding test results.
- Limit of blank (LoB)
- Limit of detection (LoD)
- 99th percentile upper-reference limit (URL)
- Coefficient of variation (CV) – total
imprecision.
10
Total Imprecision – Coefficient of Variation (CV)
Fierdoz O. Essential laboratory knowledge for the clinician. Continuing Medical Education, [S.l.], v. 30, n. 7, p. 244-248, jun. 2012.
* Cullen et al. MACE (30‐days): death (excluding clearly noncardiac, cardiac arrest, acute MI, emergency revascularization procedure, cardiogenic shock, ventricular arrhythmia requiring intervention and high‐degree AV block requiring intervention.
Regardless of the achieved NPV, cTn should always be used in conjunction with full clinical assessment, including patient history and exam, and 12-lead ECG.
Reichlin T et al. CMAJ 2015
19
Distinguishing between acute and chronic cTn elevations: DELTA TROPONIN
Korley F, Jaffe AS. JACC 2013Keller T et al. JAMA 2011
hs-cTnI as a Predictor of Vascular Events in Primary Prevention: Impact of Statin Therapy
33
Tertiles Rosuvastatin Placebo
hs-cTnI N events/
N at risk
Incidence
Rate
N events/
N at risk
Incidence
Rate
ARR
1 18 / 2058 0.42 30 / 2028 0.71 0.30
2 34 / 2286 0.68 55 / 2246 1.13 0.44
3 56 / 2147 1.17 111 / 2191 2.29 1.12
hs-cTnI as a Predictor of Vascular Events in Primary Prevention: Impact of Statin Therapy
Lowest tertile hs-cTnI: 5-year NNT of 67
Highest tertile hs-cTnT: 5-year NNT of 18
Rosuvastatin offered similar relative reductions of risk of major vascular events across baseline hs-cTnI levels.
In the highest category baseline cTnI, rosuvastatin was associated with the most substantial reduction in absolute risk of CV events and therefore the lowest NNT.