High-sensitivity cardiac troponin T concentrations below the limit of detection to exclude acute myocardial infarction: A prospective evaluation

Richard Body, Gillian Burrows, Simon Carley, Louise Cullen, Martin Than, Allan S Jaffe, Philip S. Lewis

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

BACKGROUND: Initial reports suggest that concentrations of high-sensitivity cardiac troponin T (hs-cTnT) (Roche Diagnostics Elecsys®) below the limit of blank (LoB) (3 ng/L) or limit of detection (LoD) (5 ng/L) of the assay have almost 100% negative predictive value (NPV) for acute myocardial infarction (AMI), particularly among patients without electrocardiograph (ECG) evidence of ischemia. We aimed to prospectively validate those findings. METHODS: We included adults presenting to the emergency department with suspected cardiac chest pain. Standard troponin T (cTnT) and hs-cTnT (both Roche Elecsys) were tested in samples drawn on arrival. The primary outcome was AMI, adjudicated by 2 investigators on the basis of clinical data and ≥12-h cTnT testing. We also evaluated diagnostic performance when AMI was readjudicated on the basis of hs-cTnT (≥12-h) concentrations. RESULTS: Of 463 patients included, 79 (17.1%) had AMI. Twenty-four patients (5.2%) had hs-cTnT concentrations below the LoB, although none had AMI. Ninety-six patients (20.7%) had hs-cTnT concentrations below the LoD, 1 of whom had AMI. Thus, diagnostic sensitivity was 98.7% (95% CI 87.5%-98.6%) and NPV was 99.0% (95% CI 94.3%-100.0%). Of the 17.3% (n = 80) patients with hs-cTnT below the LoD and no ECG ischemia, none had AMI. Thus, diagnostic sensitivity was 100.0% (95% CI 95.4%-100.0%) and NPV was 100.0% (95% CI 95.5%-100.0%). Sensitivity and NPV were maintained when AMI was readjudicated on the basis of hs-cTnT. CONCLUSIONS: Our findings confirm that patients with nonischemic ECG and undetectable hs-cTnT at presentation have a very low probability of AMI, although the proportion of patients affected was smaller than in previous research.

Original languageEnglish (US)
Pages (from-to)983-989
Number of pages7
JournalClinical Chemistry
Volume61
Issue number7
DOIs
StatePublished - Jul 1 2015

Fingerprint

Troponin T
Limit of Detection
Myocardial Infarction
Electrocardiography
Ischemia
Chest Pain
Hospital Emergency Service
Assays
Research Personnel

ASJC Scopus subject areas

  • Clinical Biochemistry
  • Biochemistry, medical
  • Medicine(all)

Cite this

High-sensitivity cardiac troponin T concentrations below the limit of detection to exclude acute myocardial infarction : A prospective evaluation. / Body, Richard; Burrows, Gillian; Carley, Simon; Cullen, Louise; Than, Martin; Jaffe, Allan S; Lewis, Philip S.

In: Clinical Chemistry, Vol. 61, No. 7, 01.07.2015, p. 983-989.

Research output: Contribution to journalArticle

Body, Richard ; Burrows, Gillian ; Carley, Simon ; Cullen, Louise ; Than, Martin ; Jaffe, Allan S ; Lewis, Philip S. / High-sensitivity cardiac troponin T concentrations below the limit of detection to exclude acute myocardial infarction : A prospective evaluation. In: Clinical Chemistry. 2015 ; Vol. 61, No. 7. pp. 983-989.
@article{c17a0e855b964463a28addabab5d5e41,
title = "High-sensitivity cardiac troponin T concentrations below the limit of detection to exclude acute myocardial infarction: A prospective evaluation",
abstract = "BACKGROUND: Initial reports suggest that concentrations of high-sensitivity cardiac troponin T (hs-cTnT) (Roche Diagnostics Elecsys{\circledR}) below the limit of blank (LoB) (3 ng/L) or limit of detection (LoD) (5 ng/L) of the assay have almost 100{\%} negative predictive value (NPV) for acute myocardial infarction (AMI), particularly among patients without electrocardiograph (ECG) evidence of ischemia. We aimed to prospectively validate those findings. METHODS: We included adults presenting to the emergency department with suspected cardiac chest pain. Standard troponin T (cTnT) and hs-cTnT (both Roche Elecsys) were tested in samples drawn on arrival. The primary outcome was AMI, adjudicated by 2 investigators on the basis of clinical data and ≥12-h cTnT testing. We also evaluated diagnostic performance when AMI was readjudicated on the basis of hs-cTnT (≥12-h) concentrations. RESULTS: Of 463 patients included, 79 (17.1{\%}) had AMI. Twenty-four patients (5.2{\%}) had hs-cTnT concentrations below the LoB, although none had AMI. Ninety-six patients (20.7{\%}) had hs-cTnT concentrations below the LoD, 1 of whom had AMI. Thus, diagnostic sensitivity was 98.7{\%} (95{\%} CI 87.5{\%}-98.6{\%}) and NPV was 99.0{\%} (95{\%} CI 94.3{\%}-100.0{\%}). Of the 17.3{\%} (n = 80) patients with hs-cTnT below the LoD and no ECG ischemia, none had AMI. Thus, diagnostic sensitivity was 100.0{\%} (95{\%} CI 95.4{\%}-100.0{\%}) and NPV was 100.0{\%} (95{\%} CI 95.5{\%}-100.0{\%}). Sensitivity and NPV were maintained when AMI was readjudicated on the basis of hs-cTnT. CONCLUSIONS: Our findings confirm that patients with nonischemic ECG and undetectable hs-cTnT at presentation have a very low probability of AMI, although the proportion of patients affected was smaller than in previous research.",
author = "Richard Body and Gillian Burrows and Simon Carley and Louise Cullen and Martin Than and Jaffe, {Allan S} and Lewis, {Philip S.}",
year = "2015",
month = "7",
day = "1",
doi = "10.1373/clinchem.2014.231530",
language = "English (US)",
volume = "61",
pages = "983--989",
journal = "Clinical Chemistry",
issn = "0009-9147",
publisher = "American Association for Clinical Chemistry Inc.",
number = "7",

}

TY - JOUR

T1 - High-sensitivity cardiac troponin T concentrations below the limit of detection to exclude acute myocardial infarction

T2 - A prospective evaluation

AU - Body, Richard

AU - Burrows, Gillian

AU - Carley, Simon

AU - Cullen, Louise

AU - Than, Martin

AU - Jaffe, Allan S

AU - Lewis, Philip S.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - BACKGROUND: Initial reports suggest that concentrations of high-sensitivity cardiac troponin T (hs-cTnT) (Roche Diagnostics Elecsys®) below the limit of blank (LoB) (3 ng/L) or limit of detection (LoD) (5 ng/L) of the assay have almost 100% negative predictive value (NPV) for acute myocardial infarction (AMI), particularly among patients without electrocardiograph (ECG) evidence of ischemia. We aimed to prospectively validate those findings. METHODS: We included adults presenting to the emergency department with suspected cardiac chest pain. Standard troponin T (cTnT) and hs-cTnT (both Roche Elecsys) were tested in samples drawn on arrival. The primary outcome was AMI, adjudicated by 2 investigators on the basis of clinical data and ≥12-h cTnT testing. We also evaluated diagnostic performance when AMI was readjudicated on the basis of hs-cTnT (≥12-h) concentrations. RESULTS: Of 463 patients included, 79 (17.1%) had AMI. Twenty-four patients (5.2%) had hs-cTnT concentrations below the LoB, although none had AMI. Ninety-six patients (20.7%) had hs-cTnT concentrations below the LoD, 1 of whom had AMI. Thus, diagnostic sensitivity was 98.7% (95% CI 87.5%-98.6%) and NPV was 99.0% (95% CI 94.3%-100.0%). Of the 17.3% (n = 80) patients with hs-cTnT below the LoD and no ECG ischemia, none had AMI. Thus, diagnostic sensitivity was 100.0% (95% CI 95.4%-100.0%) and NPV was 100.0% (95% CI 95.5%-100.0%). Sensitivity and NPV were maintained when AMI was readjudicated on the basis of hs-cTnT. CONCLUSIONS: Our findings confirm that patients with nonischemic ECG and undetectable hs-cTnT at presentation have a very low probability of AMI, although the proportion of patients affected was smaller than in previous research.

AB - BACKGROUND: Initial reports suggest that concentrations of high-sensitivity cardiac troponin T (hs-cTnT) (Roche Diagnostics Elecsys®) below the limit of blank (LoB) (3 ng/L) or limit of detection (LoD) (5 ng/L) of the assay have almost 100% negative predictive value (NPV) for acute myocardial infarction (AMI), particularly among patients without electrocardiograph (ECG) evidence of ischemia. We aimed to prospectively validate those findings. METHODS: We included adults presenting to the emergency department with suspected cardiac chest pain. Standard troponin T (cTnT) and hs-cTnT (both Roche Elecsys) were tested in samples drawn on arrival. The primary outcome was AMI, adjudicated by 2 investigators on the basis of clinical data and ≥12-h cTnT testing. We also evaluated diagnostic performance when AMI was readjudicated on the basis of hs-cTnT (≥12-h) concentrations. RESULTS: Of 463 patients included, 79 (17.1%) had AMI. Twenty-four patients (5.2%) had hs-cTnT concentrations below the LoB, although none had AMI. Ninety-six patients (20.7%) had hs-cTnT concentrations below the LoD, 1 of whom had AMI. Thus, diagnostic sensitivity was 98.7% (95% CI 87.5%-98.6%) and NPV was 99.0% (95% CI 94.3%-100.0%). Of the 17.3% (n = 80) patients with hs-cTnT below the LoD and no ECG ischemia, none had AMI. Thus, diagnostic sensitivity was 100.0% (95% CI 95.4%-100.0%) and NPV was 100.0% (95% CI 95.5%-100.0%). Sensitivity and NPV were maintained when AMI was readjudicated on the basis of hs-cTnT. CONCLUSIONS: Our findings confirm that patients with nonischemic ECG and undetectable hs-cTnT at presentation have a very low probability of AMI, although the proportion of patients affected was smaller than in previous research.

UR - http://www.scopus.com/inward/record.url?scp=84937417944&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937417944&partnerID=8YFLogxK

U2 - 10.1373/clinchem.2014.231530

DO - 10.1373/clinchem.2014.231530

M3 - Article

C2 - 25979953

AN - SCOPUS:84937417944

VL - 61

SP - 983

EP - 989

JO - Clinical Chemistry

JF - Clinical Chemistry

SN - 0009-9147

IS - 7

ER -