Direct Comparison of Cardiac Troponin T and I Using a Uniform and a Sex-Specific Approach in the Detection of
Deborah Mueller1, Christian Puelacher1,2, Ursina Honegger1
1Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Insights
High-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) show similar moderate accuracy for detecting functionally relevant coronary artery disease (fCAD). Both troponins also demonstrated comparable prognostic value for major adverse cardiac events.
Area of Science:
- Cardiology
- Biomarkers
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) diagnosis relies on various methods.
- High-sensitivity cardiac troponin assays (hs-cTnI and hs-cTnT) are crucial biomarkers.
- Direct comparison of hs-cTnI and hs-cTnT in detecting functionally relevant CAD (fCAD) is needed.
Purpose of the Study:
- To directly compare the diagnostic accuracy of hs-cTnI and hs-cTnT.
- To evaluate the prognostic performance of hs-cTnI and hs-cTnT for major adverse cardiac events (MACE).
- To assess the utility of sex-specific cutoffs for troponin assays.
Main Methods:
- Prospective study including patients with suspected fCAD.
- fCAD diagnosis confirmed by myocardial perfusion imaging and coronary angiography.
- hs-cTnI and hs-cTnT levels measured; diagnostic accuracy assessed via ROC curves.
- Prognostic performance evaluated for 2-year MACE using multivariable models.
Main Results:
- Overall fCAD prevalence was 29.7%.
- hs-cTnI and hs-cTnT demonstrated comparable diagnostic accuracy for fCAD in all patients, women, and men.
- Sex-specific cutoffs may optimize sensitivity and specificity.
- Both troponins were strong independent predictors of MACE with similar prognostic accuracy.
Conclusions:
- hs-cTnI and hs-cTnT offer moderate and comparable diagnostic accuracy for fCAD.
- Sex-specific cutoffs for troponin assays might enhance clinical utility.
- The prognostic value of hs-cTnI and hs-cTnT in predicting MACE is similar.
Background:
We aimed to directly compare high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) in the detection of functionally relevant coronary artery disease (fCAD).
Methods:
Consecutive patients referred with clinical suspicion of fCAD and no structural heart disease other than coronary artery disease were included. The presence of fCAD was based on rest/stress myocardial perfusion single-photon emission computed tomography/computed tomography and coronary angiography. hs-cTnI and hs-cTnT concentrations were measured in a blinded fashion. Diagnostic accuracy was quantified using the area under the ROC curve (AUC) and evaluated both for uniform use in all patients and for sex-specific use in women and men separately. The prognostic end point was major adverse cardiac events (MACEs; cardiovascular death or myocardial infarction) within 2 years. For the prognostic performance, we used a multivariable model comparison with the Akaike information criterion (AIC).
Results:
fCAD was detected in 613 of 2062 patients (29.7%) overall, 112 of 664 of women (16.9%), and 501 of 1398 of men (35.8%). hs-cTnI and hs-cTnT had comparable diagnostic accuracy when assessed for uniform use in all patients (AUC, 0.68 vs 0.66; P = 0.107) and separately in women (AUC, 0.68 vs 0.63; P = 0.068) and men (AUC, 0.65 vs 0.64; P = 0.475). However, women required lower rule-out cutoffs to achieve high sensitivity, and men needed higher rule-in cutoffs to achieve high specificity. hs-cTnI and hs-cTnT were strongly and independently associated with MACE within 2 years (P < 0.001), with comparable prognostic accuracies by the AIC.
Conclusions:
hs-cTnI and hs-cTnT provide moderate and comparable diagnostic accuracy. Sex-specific cutoffs may be preferred. The prognostic utility of both troponins is comparable.
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