A New Season for Cardiac Troponin Assays: It’s Time to Keep a Scorecard

Apple, Fred S.

doi:10.1373/clinchem.2009.128363

Cited by 392 publications

(296 citation statements)

References 16 publications

(20 reference statements)

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“…Some are based on their availability for clinical use [26] and some sort the assays by different generations [27]. Another term that has been used is 'guideline-compatible' [26].…”

Section: Classification Of Cardiac Troponin Assays According To Sensimentioning

confidence: 99%

“…Apple and others proposed to designate the assays that are currently on the market, in particular on the US market, as contemporary assays [26]. However, as previously mentioned, one drawback of this classification scheme is that as the clinical availability of the different cTn assays changes, so would their categorization as contemporary assays.…”

Section: Medium Sensitivity (Ms) Assaysmentioning

confidence: 99%

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High sensitivity cardiac troponin assays in the clinical laboratories

Jarolím

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

119

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Abstract:Immunoassays measuring cardiac troponins I or T have become firmly established as critical tools for diagnosing acute myocardial infarction. While most contemporary assays provide adequate diagnostic performance, the increased sensitivity and precision of the new, high sensitivity assays that have already been introduced into clinical practice, provide the potential to further shorten intervals between blood draws or the time needed to detect the first significant troponin elevation. In addition to the relatively modest benefits at the diagnostic end, the high sensitivity assays and the investigational ultrasensitive cardiac troponin assays offer improvements for predicting major adverse cardiovascular events, development of heart failure or transition to end-stage kidney disease. These novel high sensitivity assays can measure troponin concentrations in 50%-100% of healthy individuals and therefore allow for the distribution of troponin values within a healthy cohort to be measured, patient's baseline troponin levels to be monitored, and clinicians to be alerted of deteriorating cardiorenal conditions. We envisage that the high sensitivity assays will become important tools for predicting each patient's risk of future adverse events and for guiding and monitoring corresponding adjustments of preventative therapeutic interventions.

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“…Some are based on their availability for clinical use [26] and some sort the assays by different generations [27]. Another term that has been used is 'guideline-compatible' [26].…”

Section: Classification Of Cardiac Troponin Assays According To Sensimentioning

confidence: 99%

Section: Medium Sensitivity (Ms) Assaysmentioning

confidence: 99%

High sensitivity cardiac troponin assays in the clinical laboratories

Jarolím

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

119

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“…Current generation cTn assays [8,9] have led to an appreciation that increased cTn concentrations can be associated with myocardial necrosis independent from myocardial ischemia [10]. In particular, the availability of sensitive cTn detection [namely "high sensitive" assays (CV ≤ 10% at the 99th percentile) and "contemporary" assays (CV > 10 to 20% at the 99th percentile)] [9] could contribute more relevant information about the biochemical substrates underlying STEMI and NSTEMI.…”

Section: Introductionmentioning

confidence: 99%

“…In particular, the availability of sensitive cTn detection [namely "high sensitive" assays (CV ≤ 10% at the 99th percentile) and "contemporary" assays (CV > 10 to 20% at the 99th percentile)] [9] could contribute more relevant information about the biochemical substrates underlying STEMI and NSTEMI. Within this context, we sought to compare the average patterns and the dynamics of cTnI release in STEMI and NSTEMI patients undergoing early percutaneous coronary intervention (PCI).…”

Section: Introductionmentioning

confidence: 99%

New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay

Ferraro

Biganzoli

Marano

et al. 2013

Clinical Biochemistry

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Objectives: ST-elevation and non-ST-elevation myocardial infarction (STEMI, NSTEMI) are considered two distinct pathophysiologic entities. We evaluated cardiac troponin I (cTnI) release in STEMI and NSTEMI using a "contemporary" (CV > 10 to 20% at the 99th percentile concentration) cTnI assay for patients undergoing early percutaneous coronary intervention (PCI).Design and methods: 856 patients with suspected acute coronary syndrome consecutively admitted to the Emergency Department of the Maggiore Hospital of Novara (225 STEMI and 135 NSTEMI) were selected according to: 1) early (≤4 h from admission) and successful PCI; and 2) cTnI measurements at ED presentation and within 24 h. The influence of the MI type on cTnI concentrations at baseline and after PCI as well as the velocity of cTnI [cTnI V = absolute increase (after log conversion of cTnI measurements) / delay between the two measurements] was studied by multiple regression analysis, adjusting for patient parameters.Results: A statistically significant interaction between MI type and time from symptoms was reported on cTnI concentrations (p b 0.0001): STEMI and NSTEMI differed for cTnI releases at admission and after revascularization. Higher cTnI V in STEMI was detectable in patients admitted within 6 h from symptoms. Baseline cTnI concentrations were lower in patients with a history of coronary artery disease (CAD) and increased with aging (p b 0.0001). In the elderly (>75 years), the cTnI V was significantly increased.Conclusion: STEMI and NSTEMI patients have different patterns and dynamics of cTnI release influenced by the interaction with time from symptoms, by aging and history of CAD.

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“…Assay precision should be ≤ 10% coefficient of variation (CV) at the 99th percentile URL. Only assays with detectable troponin values in more than 50% of healthy individuals should be classified as high sensitivity assays [16]. Many currently used high sensitivity troponin assays allow measurement of cardiac troponin in almost all healthy individuals [17], leading to higher negative predictive values and allowing earlier detection of MI as compared to less sensitive cTn assays.…”

Section: Cardiac Troponin: Preferred and Gold Standard Biomarkermentioning

confidence: 99%

State-of-the-art diagnosis of myocardial infarction

Vafaie

2016

Diagnosis

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Abstract:The current version of the Universal Definition of Myocardial Infarction (MI) was published in 2012. An acute myocardial infarction (AMI) is characterized by evidence of myocardial necrosis in a clinical setting of acute myocardial ischemia. Diagnostic criteria include a rise and/or fall of serially tested cardiac biomarkers (preferentially cardiac troponins) with at least one value above the 99th percentile of the upper reference limit combined with symptoms of ischemia, new changes on electrocardiogram (ECG), imaging evidence of a new loss of viable myocardium or new regional wall motion abnormalities or the identification of an intracoronary thrombus by angiography or autopsy. Compared to previous versions, the current definition of MI includes minor modifications regarding ECG criteria and subtypes of MI as well as the use of cardiac imaging and high sensitivity troponin assays. This article summarizes the Universal MI definition and includes recommendations from the current guidelines for the management of patients with acute coronary syndrome. Strategies for "early rule-in" and "rule-out" of non-ST-elevation MI with high sensitivity cardiac troponin assays, risk scores for assessment of ischemic and bleeding risk and criteria for optimal timing of angiography are presented.

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A New Season for Cardiac Troponin Assays: It’s Time to Keep a Scorecard

Cited by 392 publications

References 16 publications

High sensitivity cardiac troponin assays in the clinical laboratories

High sensitivity cardiac troponin assays in the clinical laboratories

New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay

State-of-the-art diagnosis of myocardial infarction

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