A comparison of cardiac troponin T delta change methods and the importance of the clinical context in the assessment of acute coronary syndrome

Simpson, Paul; Tirimacco, Rosy; Cowley, P.; Siew, May; Berry, Narelle M.; Tate, Jill; Tideman, Philip

doi:10.1177/0004563219876671

Cited by 3 publications

(2 citation statements)

References 26 publications

(34 reference statements)

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“…5 Similar performance for the diagnosis of AMI was also recently shown using z-scores for the Roche hs-TnT assay. 9 Overall, the performance of z-score was equivalent to an absolute delta change and better than a relative delta change for the diagnosis of AMI. 5,9 Despite the excellent diagnostic accuracy of z-scores for the diagnosis of AMI, there have been few studies assessing the association with other cardiac diagnoses and cardiac intervention.…”

Section: Introductionmentioning

confidence: 87%

“…9 Overall, the performance of z-score was equivalent to an absolute delta change and better than a relative delta change for the diagnosis of AMI. 5,9 Despite the excellent diagnostic accuracy of z-scores for the diagnosis of AMI, there have been few studies assessing the association with other cardiac diagnoses and cardiac intervention. Additionally, clinical outcomes of patients with non-dynamic troponin elevations (as defined by a normal z-score) remain largely unknown.…”

Section: Introductionmentioning

confidence: 87%

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Troponin least significant change (z-score) is associated with poor clinical outcomes in patients presenting to the emergency department

et al. 2021

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Background A rise and/or fall in high sensitivity cardiac troponin (hs-Tn) is critical in defining acute myocardial injury and therefore the diagnosis of acute myocardial infarction. A significant rise in hs-Tn is not well defined in current guidelines. Calculation of a z-score for two consecutive hs-Tn measurements is a method-independent measure of dynamic troponin elevation. However, the association of hs-Tn z-score with outcomes for unselected emergency department admissions is unknown. Moreover, the association of non-dynamic troponin elevations, as defined by a normal z-score, with clinical outcomes remains to be assessed. Methods We retrospectively calculated z-scores for patients presenting to emergency department over 18 months who had serial troponin measurements with at least one result >99th percentile using the Abbott hs-TnI assay. We assessed the association of z-score with discharge diagnosis, cardiac interventions, inpatient mortality, length of stay and readmission rates. Results There were 2062 presentations for 1830 patients where a z-score was calculated. Z-score was elevated in 1080 presentations. Dynamic troponin elevation (z-score ≥ 2) was associated with acute myocardial infarction (OR = 9.1, P < 0.01), admission to an inpatient unit (95 vs. 88%, P < 0.01), increased inpatient length of stay (97 vs. 65 days, P < 0.01), inpatient coronary intervention (21 vs. 6%, P < 0.01) and mortality (4.4 vs. 2.4%, P < 0.05) compared with myocardial injury with a static troponin elevation. Conclusions Z-score is an assay-independent tool to alert clinicians of significant, dynamic troponin elevation and acute myocardial injury. It is associated with poorer clinical outcomes.

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Section: Introductionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 87%

Troponin least significant change (z-score) is associated with poor clinical outcomes in patients presenting to the emergency department

et al. 2021

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Establishing optimal cutoff values for high-sensitivity cardiac troponin algorithms in risk stratification of acute myocardial infarction

Liu

Lewandrowski

2023

Critical Reviews in Clinical Laboratory Sciences

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Absolute Versus Relative Changes in Cardiac Troponins in the Diagnosis of Myocardial Infarction: A Systematic Review and Meta-Analysis

Ravanavena¹,

Ravindra²,

Igweonu-Nwakile³

et al. 2022

Cureus

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Ischemic heart disease (IHD) is one of the leading causes of death globally. Rapid diagnosis of myocardial infarction (MI) will enable earlier initiation of the treatment and improve patient outcomes. Practice guidelines for non-ST-elevation acute coronary syndromes by the American College of Cardiology (ACC)/American Heart Association (AHA) had listed the diagnostic performance of absolute versus relative changes in evidence gaps. We aimed to address this evidence gap by examining the diagnostic accuracy of absolute versus relative changes in cardiac troponins at various time intervals in diagnosing MI. Grey literature, conference abstracts, animal studies, and reports published before 2009 and in languages other than English were excluded. We included reports that investigated absolute or relative changes in highly sensitive cardiac troponin T (hs-cTnT) or sensitive/highly sensitive cardiac troponin I (s/hs-cTnI) assays after specific time intervals (1, 2, or 3 h) in patients presenting with symptoms suggestive of the acute coronary syndrome. After screening, we arranged the reports in 12 separate groups based on the variables for which the data was reported. Quality assessment of the diagnostic accuracy studies-2 (QUADAS-2) was used to assess the risk of bias in the included studies. The weighted summary area under the curve (AUC) was calculated for each pool. We then performed two-sided (or two-tailed) tests to compare independent receiver operating characteristic (ROC) curves. MedCalc version 20.106 (MedCalc Software Ltd., Ostend, Belgium) was used for all statistical analysis. We included eight reports with 23,450 patients in the meta-analysis. Weighted summary estimates and their respective 95% confidence intervals (CI) under random-effects model for ROC-AUC are as follows: absolute hs-cTnI at 1 h - 0.94 (95% CI: 0.922 to 0.959, p < 0.001); absolute hs-cTnT at 1 h - 0.921 (95% CI: 0.902 to 0.941, p < 0.001); absolute s/hs-cTnI at 2 h - 0.953 (95% CI: 0.926 to 0.980, p < 0.001); absolute hs-cTnT at 2 h 0.951 (95% CI: 0.940 to 0.962, p < 0.001); relative hs-cTnT at 2 h - 0.818 (95% CI: 0.733 to 0.903, p < 0.001); relative s/hs-cTnI at 2 h - 0.762 (95% CI: 0.726 to 0.798, p < 0.001); absolute hs-cTnI at 3 h - 0.967 (95% CI: 0.95 to 0.984, p < 0.001); absolute hs-cTnT at 3 h - 0.959 (95% CI: 0.950 to 0.968, p < 0.001); and relative hs-cTnT at 3 h - 0.926 (95% CI: 0.907 to 0.945, p < 0.001). P-values of comparison of absolute and relative changes are as follows: hs-cTnT at 1 h: <0.0001; hs-cTnI at 1 h: <0.0001; hs-cTnT at 2 h: 0.0024; s/hs-cTnI at 2 h: <0.0001; hs-cTnT at 3 h: 0.0022; and hs-cTnI at 3 h: 0.0005. Our analysis found absolute changes to be superior to relative changes in both hs-cTnT and s/hs-cTnI at 1, 2, and 3 h in the diagnosis of MI. There was no statistically significant difference in comparing s/hs-cTnI vs. hs-cTnT using absolute or relative changes at any time interval. Our findings suggest that future research investigating a potential 0 h/30 min algorithm should use absol...

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A comparison of cardiac troponin T delta change methods and the importance of the clinical context in the assessment of acute coronary syndrome

Cited by 3 publications

References 26 publications

Troponin least significant change (z-score) is associated with poor clinical outcomes in patients presenting to the emergency department

Troponin least significant change (z-score) is associated with poor clinical outcomes in patients presenting to the emergency department

Establishing optimal cutoff values for high-sensitivity cardiac troponin algorithms in risk stratification of acute myocardial infarction

Absolute Versus Relative Changes in Cardiac Troponins in the Diagnosis of Myocardial Infarction: A Systematic Review and Meta-Analysis

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