Diagnostic Reclassification by a High-Sensitivity Cardiac Troponin Assay
Bryn E Mumma1, Scott D Casey1, Robert K Dang1
1Department of Emergency Medicine, University of California, Davis, Sacramento, CA.
Annals of Emergency Medicine
|August 19, 2020
Summary
High-sensitivity cardiac troponin T (hs-cTnT) assays identify more myocardial injury cases than conventional troponin I (cTnI) but do not significantly alter myocardial infarction diagnoses in emergency department patients.
Area of Science:
- Cardiology
- Clinical Chemistry
- Emergency Medicine
Background:
- Cardiac troponin assays are crucial for diagnosing myocardial infarction and injury.
- Conventional cardiac troponin I (cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) have different performance characteristics.
- Understanding diagnostic reclassification between these assays is important for clinical practice.
Purpose of the Study:
- To compare diagnostic reclassification rates between cTnI and hs-cTnT assays.
- To evaluate reclassification using combined and sex-specific hs-cTnT thresholds.
- To analyze these differences in adult emergency department (ED) patients.
Main Methods:
- Prospective, single-center, before-and-after observational study.
- Included ED patients (≥18 years) undergoing troponin testing.
- Compared cTnI and hs-cTnT results using physician adjudication and Fourth Universal Definition of Myocardial Infarction criteria.
Main Results:
- 1,016 patients were studied (median age 60 years).
- 0.6% of patients were reclassified for myocardial infarction between cTnI and hs-cTnT.
- 16% of patients were reclassified for myocardial injury, with hs-cTnT identifying more cases.
Conclusions:
- hs-cTnT assays lead to a substantial increase in myocardial injury diagnoses compared to cTnI.
- No clinically significant change in myocardial infarction diagnoses was observed.
- The findings highlight the impact of hs-cTnT on diagnosing myocardial injury in the ED.
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