Using high-sensitivity troponin T: The importance of the proper gold standard

Miguel Santaló, Alfonso Martin, Joaquin Velilla, Juan Povar, Francisco Temboury, Jose Balaguer, Mar Muñoz, Pilar Calmarza, Carmen Ortiz, Arturo Carratalá, Ignacio Gich, Javier Mercé, Allan S. Jaffe, Jordi Ordoñez-Llanos

Research output: Contribution to journalArticlepeer-review

37 Scopus citations

Abstract

Objective: The study objective was to determine how best to use high-sensitivity cardiac troponin T (hscTnT) to diagnose myocardial infarction. Methods: A total of 358 patients presenting with acute coronary syndromes sampled at admission and 2, 4, and 6 to 8 hours. Both contemporary cardiac troponin T (cTnT) and hscTnT were measured. Patients were classified with conventional cTnT values by independent investigators. Myocardial infarction required a cTnT value ≥99th reference percentile and a ≥20% change. Results: Seventy-nine patients had non-ST-segment elevation myocardial infarction, 105 patients had unstable angina, and 174 patients had nonacute coronary syndromes. A cTnT cutoff at the 10% coefficient of variation value missed 14.5% of infarctions. hscTnT had a sensitivity at admission of 89.9%, but specificity was only 75.1% because of elevations in 45.3% and 25.3% of those with unstable angina and nonacute coronary syndromes, respectively. The optimal value for myocardial infarction diagnosis with hscTnT was 25 ng/L at admission and 30 ng/L during serial sampling. All infarctions were diagnosed within 4 hours, with a time saving of 11 and 68 minutes compared with a cTnT value at the 99th reference percentile value and a cTnT value at a coefficient of variation of 10%. By using the 99th percentile of hsTnT plus a ≥20% change, 25 additional infarctions were identified. With these included, the optimal cutoff decreased to 12 ng/L at admission and 13 ng/L over time, but time to diagnosis increased. Conclusions: The gold standard used to diagnose myocardial infarction makes a major difference in the results. When myocardial infarction is diagnosed using hscTnT 99th percentile values with a 20% change, more are identified, diagnosis is delayed, and the optimal value for use is reduced.

Original languageEnglish (US)
Pages (from-to)709-717
Number of pages9
JournalAmerican Journal of Medicine
Volume126
Issue number8
DOIs
StatePublished - Aug 1 2013

Keywords

  • High-sensitivity troponin T
  • Non-ST-segment elevation myocardial infarction

ASJC Scopus subject areas

  • Medicine(all)

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