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Consideration of high-sensitivity troponin values below the 99th percentile at presentation: does it improve

Christophe Meune1, Cathrin Balmelli, Eliane Vogler

  • 1Department of Cardiology, University Hospital, Basel, Switzerland; Paris XIII University, Cardiology Department, Avicenne Hospital, Bobigny, France; Paris Descartes University, Cardiology Department, Cochin Hospital, APHP, Paris, France.

International Journal of Cardiology
|July 16, 2013
PubMed

Insights

High-sensitivity cardiac troponin (hs-cTn) assays can assess values below the 99th percentile for acute myocardial infarction (AMI) diagnosis. Lower cut-offs like the 75th percentile offer high negative predictive value but reduced accuracy compared to the 99th percentile.

Area of Science:

  • Cardiology
  • Clinical Diagnostics
  • Biomarker Research

Background:

  • Introduction of high-sensitivity cardiac troponin (hs-cTn) assays enables evaluation of clinical decision values below the 99th percentile.
  • Hs-cTn assays provide enhanced sensitivity for detecting cardiac injury.

Purpose of the Study:

  • To evaluate the diagnostic performance of hs-cTn assays at various percentile cut-offs for acute myocardial infarction (AMI).
  • To assess the association between hs-cTn levels below the 99th percentile and one-year mortality in patients with acute chest pain.

Main Methods:

  • Prospective, multicenter cohort study of 1181 patients with acute chest pain.
  • Blinded measurement of hs-cTnT (Roche) and cTnI-ultra (Siemens) assays.
  • Adjudication of final diagnosis and one-year mortality.

Main Results:

  • Hs-cTnT and cTnI-ultra were below the 99th percentile in 63% and 77% of patients, respectively.
  • Sensitivities for AMI diagnosis decreased with lower cut-offs, while the proportion of correctly classified patients increased.
  • One-year all-cause mortality was low and similar across all tested hs-cTn cut-off levels (0.7%-1.5%).

Conclusions:

  • Cardiac troponin (cTn) should be considered a continuous variable.
  • Decision values below the 99th percentile, such as the 75th percentile, demonstrate high negative predictive value for AMI but lower accuracy than the 99th percentile.
Abstract

Keywords:
75th percentile95th percentileAcute coronary syndromeHigh sensitivity Troponin

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