Defining a reference population to determine the 99th percentile of a contemporary sensitive cardiac troponin I assay
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Defining a reference population to determine the 99th percentile of a contemporary sensitive cardiac troponin I assay. / Keller, Till; Ojeda, Francisco; Zeller, Tanja; Wild, Philipp S; Tzikas, Stergios; Sinning, Christoph R; Peetz, Dirk; Münzel, Thomas; Blankenberg, Stefan; Lackner, Karl J.
in: INT J CARDIOL, Jahrgang 167, Nr. 4, 20.08.2013, S. 1423-1439.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Defining a reference population to determine the 99th percentile of a contemporary sensitive cardiac troponin I assay
AU - Keller, Till
AU - Ojeda, Francisco
AU - Zeller, Tanja
AU - Wild, Philipp S
AU - Tzikas, Stergios
AU - Sinning, Christoph R
AU - Peetz, Dirk
AU - Münzel, Thomas
AU - Blankenberg, Stefan
AU - Lackner, Karl J
N1 - Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
PY - 2013/8/20
Y1 - 2013/8/20
N2 - BACKGROUND: Diagnosis of acute myocardial infarction (AMI) according to the universal definition is based on ischemic symptoms, imaging findings and elevated myocardial necrosis markers, preferably cardiac troponin I/T with diagnostic threshold representing the 99th percentile of a reference population. It is not clearly defined if this should be an unselected population-based or a healthy cohort with respect to cardiac diseases. Aim of the current study was to describe the distribution of troponin I using a sensitive assay and to evaluate the impact of cardiac diseases and cardiovascular risk factors in apparently healthy individuals.METHODS: Troponin I was determined using a contemporary sensitive assay (TnI Ultra, Siemens) with 10% coefficient of variation (0.03 ng/mL) below the published 99th percentile (0.04 ng/mL) in 5000 participants (49.2% female) of the Gutenberg Health Study, a community-based, prospective, observational single-center cohort study. The calculated 99 th percentile cut-offs were tested in 1818 patients with suspected AMI.RESULTS: Troponin I concentration representing the 99th percentile of the overall study population was 0.04 ng/mL. Excluding individuals with prevalent cardiovascular disease lowers the 99th percentile to 0.034 ng/mL. Exclusion of individuals with traditional risk factors or elevated natriuretic peptide leads to further reduction with 0.029/0.028 ng/mL. These lower cut-offs detect more patients at risk in individuals with suspected AMI. Correlations of troponin I with age, gender and traditional risk factors were observed.CONCLUSIONS: Troponin I concentrations in apparently healthy individuals are dependent on prevalent cardiovascular diseases, traditional risk factors, gender and age. Application of corresponding cut-offs in diagnosis of AMI alters the group of patients potentially at risk.
AB - BACKGROUND: Diagnosis of acute myocardial infarction (AMI) according to the universal definition is based on ischemic symptoms, imaging findings and elevated myocardial necrosis markers, preferably cardiac troponin I/T with diagnostic threshold representing the 99th percentile of a reference population. It is not clearly defined if this should be an unselected population-based or a healthy cohort with respect to cardiac diseases. Aim of the current study was to describe the distribution of troponin I using a sensitive assay and to evaluate the impact of cardiac diseases and cardiovascular risk factors in apparently healthy individuals.METHODS: Troponin I was determined using a contemporary sensitive assay (TnI Ultra, Siemens) with 10% coefficient of variation (0.03 ng/mL) below the published 99th percentile (0.04 ng/mL) in 5000 participants (49.2% female) of the Gutenberg Health Study, a community-based, prospective, observational single-center cohort study. The calculated 99 th percentile cut-offs were tested in 1818 patients with suspected AMI.RESULTS: Troponin I concentration representing the 99th percentile of the overall study population was 0.04 ng/mL. Excluding individuals with prevalent cardiovascular disease lowers the 99th percentile to 0.034 ng/mL. Exclusion of individuals with traditional risk factors or elevated natriuretic peptide leads to further reduction with 0.029/0.028 ng/mL. These lower cut-offs detect more patients at risk in individuals with suspected AMI. Correlations of troponin I with age, gender and traditional risk factors were observed.CONCLUSIONS: Troponin I concentrations in apparently healthy individuals are dependent on prevalent cardiovascular diseases, traditional risk factors, gender and age. Application of corresponding cut-offs in diagnosis of AMI alters the group of patients potentially at risk.
KW - Adult
KW - Age Factors
KW - Aged
KW - Biomarkers/blood
KW - Cardiovascular Diseases/blood
KW - Cohort Studies
KW - Cross-Sectional Studies
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Population Surveillance/methods
KW - Prospective Studies
KW - Reference Values
KW - Risk Factors
KW - Sex Factors
KW - Troponin I/blood
U2 - 10.1016/j.ijcard.2012.04.063
DO - 10.1016/j.ijcard.2012.04.063
M3 - SCORING: Journal article
C2 - 22560907
VL - 167
SP - 1423
EP - 1439
JO - INT J CARDIOL
JF - INT J CARDIOL
SN - 0167-5273
IS - 4
ER -