Consideration of high-sensitivity troponin values below the 99th percentile at presentation: Does it improve diagnostic accuracy?

TY - JOUR

T1 - Consideration of high-sensitivity troponin values below the 99th percentile at presentation: Does it improve diagnostic accuracy?

AU - Meune, Christophe

AU - Balmelli, Cathrin

AU - Vogler, Eliane

AU - Twerenbold, Raphael

AU - Reiter, Miriam

AU - Reichlin, Tobias

AU - Haaf, Philip

AU - Drexler, Beatrice

AU - Wildi, Karin

AU - Hoeller, Rebeca

AU - Rubini Gimenez, Maria

AU - Moehring, Berit

AU - Zellweger, Christa

AU - Potocki, Mihael

AU - Mueller, Christian

N1 - Funding Information: This study was supported by grants from the Swiss National Science Foundation , the Swiss Heart Foundation , Abbott , Roche , Siemens , and the Department of Internal Medicine, University Hospital Basel and the University Basel . We disclose that Dr. Mueller reports receiving research grant support from Abbott, Beckman Coulter, Brahms, Bühlmann, Nanosphere, Roche, and Siemens, consulting fees from Abbott, Alere, BRAHMS, Roche and Siemens and lecture fees from Abbott, Alere, Brahms, Roche, and Siemens. Dr. Reichlin has received research grants from the University of Basel and the Department of Internal Medicine, University Hospital Basel as well as speaker honoraria from Brahms, and Roche. Dr. Meune was supported a grant from the FreieAkademischeGesellschaft Basel (FAG), and received lecture fees from Roche Diagnostics. All other authors declare that they have no conflict of interest. The sponsors had no role in study design, data analysis and interpretation.

PY - 2013/10/9

Y1 - 2013/10/9

N2 - Background The introduction of high-sensitivity cardiac troponin (hs-cTn) assays allows the assessment of clinical decision values below the 99th percentile. Methods Final diagnosis and one-year mortality were adjudicated in a multicenter, prospective cohort of 1181 patients presenting with acute chest pain to the emergency department. Hs-cTnT (Roche) and cTnI-ultra (Siemens) were measured in a blinded fashion. Results At presentation hs-cTnT and cTnI-ultra were below the limit of blank (LOB) in 201 (17%) and 549 (47%) patients, below the 75th percentile in 379 (32%) and 623 (53%) patients, below the 95th percentile in 603 (51%) and 808 (68%), and below the 99th percentile in 748 (63%) and 913 (77%), respectively. Sensitivities for the diagnosis of AMI were 100.0% and 96.8% respectively for hs-cTnT and cTnI-ultra (LOB as cut-off value), 99.5% and 96.2% (75th percentile), 96.8% and 93.0% (95th percentile), and 94.1% and 88.1% (99th percentile). The proportion of patients correctly classified as having or not AMI increased from 32.9% (LOB as cut-off value) to 47.8% (75th percentile), 65.9% (95th percentile) and 77.3% (99th percentile) for hs-cTnT and from 61.2% to 67.3%, 81.9% and 89.3% respectively for cTnI-ultra. At 1 year, all-cause mortality was very low and similar for patients below all of these cut-off levels (between 0.7% and 1.5%, p = 0.748 for all-groups comparison). Conclusion cTn should be considered as a continuous variable. Decision values below the 99th percentile (e.g. the 75th percentile) are associated with a very high NPV for the diagnosis of AMI, but have a lower accuracy than the 99th percentile.

AB - Background The introduction of high-sensitivity cardiac troponin (hs-cTn) assays allows the assessment of clinical decision values below the 99th percentile. Methods Final diagnosis and one-year mortality were adjudicated in a multicenter, prospective cohort of 1181 patients presenting with acute chest pain to the emergency department. Hs-cTnT (Roche) and cTnI-ultra (Siemens) were measured in a blinded fashion. Results At presentation hs-cTnT and cTnI-ultra were below the limit of blank (LOB) in 201 (17%) and 549 (47%) patients, below the 75th percentile in 379 (32%) and 623 (53%) patients, below the 95th percentile in 603 (51%) and 808 (68%), and below the 99th percentile in 748 (63%) and 913 (77%), respectively. Sensitivities for the diagnosis of AMI were 100.0% and 96.8% respectively for hs-cTnT and cTnI-ultra (LOB as cut-off value), 99.5% and 96.2% (75th percentile), 96.8% and 93.0% (95th percentile), and 94.1% and 88.1% (99th percentile). The proportion of patients correctly classified as having or not AMI increased from 32.9% (LOB as cut-off value) to 47.8% (75th percentile), 65.9% (95th percentile) and 77.3% (99th percentile) for hs-cTnT and from 61.2% to 67.3%, 81.9% and 89.3% respectively for cTnI-ultra. At 1 year, all-cause mortality was very low and similar for patients below all of these cut-off levels (between 0.7% and 1.5%, p = 0.748 for all-groups comparison). Conclusion cTn should be considered as a continuous variable. Decision values below the 99th percentile (e.g. the 75th percentile) are associated with a very high NPV for the diagnosis of AMI, but have a lower accuracy than the 99th percentile.

KW - 75th percentile

KW - 95th percentile

KW - Acute coronary syndrome

KW - High sensitivity Troponin

UR - http://www.scopus.com/inward/record.url?scp=84886292751&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2013.06.011

DO - 10.1016/j.ijcard.2013.06.011

M3 - SCORING: Journal article

C2 - 23849971

AN - SCOPUS:84886292751

VL - 168

SP - 3752

EP - 3757

JO - INT J CARDIOL

JF - INT J CARDIOL

SN - 0167-5273

IS - 4

ER -