Background: The European Society of Cardiology/ American College of Cardiology (ESC/ACC) consensus document for definition of myocardial infarction (MI)is predicated on increased cardiac troponin or creatine kinase (CK) MB mass above the 99th percentile reference limit. The purpose of this study was to determine the plasma (heparin) 99th percentile reference limits for the leading in vitro diagnostic cardiac troponin and CKMB mass assays. Methods: Blood (heparin plasma) was obtained from healthy adults (n ؍ 696; age range, 18 -84 years) stratified by gender and ethnicity. Cardiac troponin I (cTnI) and T (cTnT) and CKMB mass concentrations were measured by eight assays. Reference limits were determined by nonparametric statistical analysis. Results: Two cTnI assays demonstrated at least a 1.2-to 2.5-fold higher 99th percentile for males vs females, with the mean concentrations significantly higher for males (P <0.05). Two cTnI assays also demonstrated a 1.1-to 2.8-fold higher 99th percentile for blacks vs Caucasians, with the mean concentrations significantly higher for blacks (P ؍ 0.05). There was a 13-fold variance between the lowest measured 99th percentile (0.06 g/L) and the highest (0.8 g/L). All CKMB assays demonstrated a 1.2-to 2.6-fold higher 99th percentile for males vs females, with mean concentrations signifi-
As such, there is currently no strong evidence for the use of pharmacogenomic testing in optimizing the safety and efficacy of DOAC therapy. Nonetheless, genes of interest have been identified for each DOAC that may be of potential clinical utility. Further research is currently underway to elucidate the value of pharmacogenomics in this increasingly prescribed therapy.
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