Diagnosis of Type 1 and Type 2 Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay with Sex-Specific 99th Percentiles Based on the Third Universal Definition of Myocardial Infarction Classification System

Sandoval, Yader; Smith, Stephen W.; Schulz, Karen; Murakami, MaryAnn M.; Love, Sara A.; Nicholson, Jennifer L.; Apple, Fred S.

doi:10.1373/clinchem.2014.236638

Cited by 58 publications

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References 12 publications

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“…5,6,9 While troponin tests are mainly used to diagnose an ACS, troponin levels can also be elevated in other cardiac conditions such as heart failure, tachyarrhythmias and post-cardiac arrest and direct current cardioversion as well as noncardiac conditions such as cerebrovascular accidents, head injuries, sepsis and pulmonary emboli. [2][3][4] In these circumstances, a troponin test should only be performed if there is strong suspicion of an ACS-such as prior chest pain or ECG changes-as a positive result can be misleading. 5,6 Interestingly, although 97 patients in the current study had a final cardiac-related diagnosis, only eight of these patients (8.2%) were diagnosed with an ACS.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 However, because the troponin test is very sensitive, an inevitable number of false-positive results is to be expected. 4 As the main reason for testing cardiac troponin is to rule out an acute coronary syndrome (ACS), it is thus essential that troponin is only checked in circumstances where the probability of ischaemic heart disease is high and an ACS is suspected, especially as indiscriminate troponin testing can lead to unnecessary investigations or a misdiagnosis. 5,6 This study therefore aimed to review patterns of troponin testing among patients attending the ED of the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman, and to examine whether initial troponin test results had an effect on patient management, especially length of hospital stay (LOS).…”

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confidence: 99%

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Troponin Testing in the Emergency Department: Real world experience

Almaskari

Al-Makhdami

Al-Lawati

et al. 2018

Sultan Qaboos Univ Med J

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abstract:Objectives: The aim of this study was to examine patterns of troponin testing in the emergency department of a large tertiary care hospital in Oman and to determine its effect on patient management, including length of hospital stay (LOS). Methods: This retrospective study analysed the medical records of all adult patients undergoing troponin testing in the emergency department of the Sultan Qaboos University Hospital, Muscat, Oman, during the month of July 2015. Patients who presented with an ST-elevation myocardial infarction were excluded. Results: A total of 4,845 patients attended the emergency department during the study period; of these, troponin tests were ordered for 588 patients. The majority of the patients had negative troponin test results (81.3%). Chest pain, palpitations and breathlessness were the most common presenting complaints for those with positive troponin results. However, 41.8% of patients did not have any cardiac symptoms. Individuals with positive troponin tests had a significantly longer LOS compared to those with negative tests (mean: three versus one day; P = 0.001). In total, only 28.2% of those with positive troponin test results had final diagnoses associated with a cardiac condition, such as heart failure, an acute coronary syndrome (ACS), atrial fibrillation or other types of arrhythmia. Conclusion: A positive troponin test was associated with increased LOS; however, only a small proportion of these patients had a final diagnosis associated with a cardiac condition. Guidelines should be provided to ensure that troponin testing is performed only in cases where an ACS is suspected.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Troponin Testing in the Emergency Department: Real world experience

Almaskari

Al-Makhdami

Al-Lawati

et al. 2018

Sultan Qaboos Univ Med J

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“…A more stringent interpretation would limit the extent to which raised cTnI was translated to type II AMI diagnosis. Stringency varies across centers, and the frequency of type II AMI diagnosis has been described as between 25% and 75% of AMI diagnoses (12,13 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of High-Sensitivity Troponin I Testing with Sex-Specific Cutoffs on the Diagnosis of Acute Myocardial Infarction

et al. 2016

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BACKGROUND: High-sensitivity cardiac troponin I (hscTnI) assays show sex-dependent differences in the 99th percentile of healthy populations, with concentrations in women approximately 50% lower. The adoption of sex-specific cutoffs seems appropriate, although it is not yet clear what effect these will have on acute myocardial infarction (AMI) diagnosis and management. METHODS:We conducted a retrospective pre-and postchangeover analysis of troponin I testing in the 6 months before and after moving from the contemporary Abbott Architect TnI assay (cTnI) to hs-cTnI at 2 tertiary centers in Australia and New Zealand. The cTnI cutoff was 30 ng/L for both sexes, whereas a female-specific cutoff of 16 ng/L was adopted upon changeover to hsTnI. RESULTS:Changeover from the cTnI assay to the hs-cTnI assay increased the number of female patients with increased troponin I concentrations at both sites (from 29.7% to 34.9% and from 22.4% to 30.8%; P Ͻ 0.001). There was no statistically significant change in the number of men with increased concentrations in the same time period (P ϭ 0.09). The increased percentage of women with increased troponin I was not associated with an increase in the number of women with AMI diagnoses at either center. Angiographic data available from 1 center showed no change in the percentage of angiograms performed in women. CONCLUSIONS:Although increasing the proportion of women with increased troponin I, adopting sex-specific cutoffs with the hs-cTnI assay did not lead to an increase in AMI diagnoses in females, or in the number of women undergoing angiography. © 2016 American Association for Clinical ChemistryCardiac troponins are the preferred biomarkers for the detection of myocardial injury, and a rise and/or fall above the 99th percentile is an integral part of the universal consensus definition for diagnosis of acute myocardial infarction (AMI) 8 (1 ). In recent years, technical improvements have led to the development of highsensitivity assays that are capable of measuring low concentrations of cardiac troponin with high precision. With such assays, we are now able to measure cardiac troponin in the serum of healthy individuals, including children, who have no evidence of cardiovascular disease (2-4 ). The advent of high-sensitivity assays has uncovered sexspecific differences in circulating cardiac troponin concentrations that were formerly unrecognized because previous assays could not measure cardiac troponin with sufficient precision at or below the 99th percentile. It is now clear that the 99th percentile is substantially lower in females than it is in males (2,(5)(6)(7). Accordingly, several laboratories have implemented sex-specific reference intervals for cTnI, although the clinical impact is as yet unclear.The revelation of sex-dependent differences in circulating cardiac troponin raises several questions regarding the interpretation of cardiac troponin in women, and its possible downstream clinical effects. These are particularly pertinent given the large body of evidence suggest...

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“…For example, a contemporary cTnI assay result of 0.030 g/L was expressed as 30 ng/L. Analytical characteristics of the contemporary cTnI assay were as follows: LoD, 10 ng/L (per manufacturer); 2% of values were measureable above the LoD in a reference population (7 ); 99th percentile, 30 ng/L, validated at Hennepin County Medical Center; and 16% CV at 35 ng/L (8 ). Analytical characteristics for the research hs-cTnI assay (ARCHITECT STAT hs-cTnI assay; Abbott Laboratories), measured immediately after the contemporary cTnI assay, were as follows: LoD, 1.9 ng/L (per manufacturer); 88% of values were measurable above the LoD in a reference population (7 ); sex-specific 99th percentiles were 16 ng/L for women and 34 ng/L for men (7,9 ); and 5.3% CV at 15 ng/L (8 ).…”

Section: Methodsmentioning

confidence: 99%

Incidence of Undetectable, Measurable, and Increased Cardiac Troponin I Concentrations Above the 99th Percentile Using a High-Sensitivity vs a Contemporary Assay in Patients Presenting to the Emergency Department

et al. 2016

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INTRODUCTION We compared the incidence of undetectable [below the limit of detection (LoD)], measurable (LoD to 99th percentile), and increased cardiac troponin I (cTnI) concentrations above the 99th percentile between Abbott high-sensitivity cTnI (hs-cTnI) and contemporary cTnI assays in a US emergency department population. METHODS Patients (n = 2100) presenting to the emergency department who had serial cTnI (0, 3, 6, 9 h) measurements ordered on clinical indication were enrolled. Contemporary cTnI [Abbott Architect used clinically; 99th percentile: 0.030 μg/L (30 ng/L)] and hs-cTnI [Abbott investigational; sex-specific 99th percentiles: female (F) 16 ng/L, male (M) 34 ng/L] assays simultaneously measured fresh EDTA plasma. RESULTS The hs-cTnI assay measured fewer undetectable cTnI concentrations compared to the contemporary cTnI assay across baseline (F: 31% vs 47%, M: 22% vs 40%) and serial (F: 21% vs 46%; M: 19% vs 54%) measurements. Conversely, the proportion of measurable cTnI concentrations was higher using hs-cTnI compared to contemporary cTnI assay across both baseline (F: 46% vs 31%; M: 60% vs 33%) and serial (F: 48% vs 28%; M: 83% vs 40%) measurements. The overall proportion of patients with increased cTnI concentrations above the 99th percentile was not significantly different between the contemporary (31%) and hs-cTnI (26%) assays (P = 0.09). CONCLUSIONS In patients presenting to the emergency department, the use of the Abbott hs-cTnI assay provides clinicians with more numeric cTnI concentrations. This occurs via a shift from results below the LoD to those between the LoD and the 99th percentile and does not increase in the number of cTnI concentrations above the 99th percentile.

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Diagnosis of Type 1 and Type 2 Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay with Sex-Specific 99th Percentiles Based on the Third Universal Definition of Myocardial Infarction Classification System

Cited by 58 publications

References 12 publications

Troponin Testing in the Emergency Department: Real world experience

Troponin Testing in the Emergency Department: Real world experience

Impact of High-Sensitivity Troponin I Testing with Sex-Specific Cutoffs on the Diagnosis of Acute Myocardial Infarction

Incidence of Undetectable, Measurable, and Increased Cardiac Troponin I Concentrations Above the 99th Percentile Using a High-Sensitivity vs a Contemporary Assay in Patients Presenting to the Emergency Department

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