Application of High-Sensitivity Troponin in Suspected Myocardial Infarction

Neumann, Johannes; Twerenbold, Raphael; Ojeda, Francisco; Sörensen, Nils Arne; Chapman, Andrew R.; Shah, Anoop; Anand, Atul; Boeddinghaus, Jasper; Nestelberger, Thomas; Badertscher, Patrick; Mokhtari, Arash; Pickering, John W.; Troughton, Richard W.; Greenslade, Jaimi; Parsonage, William; Mueller‐Hennessen, Matthias; Gori, Tommaso; Jernberg, Tomas; Morris, Niall; Liebetrau, Christoph; Hamm, Christian W.; Katus, Hugo A.; Münzel, Thomas; Landmesser, Ulf; Salomaa, Veikko; Iacoviello, Licia; Ferrario, Marco; Giampaoli, Simona; Kee, Frank; Thorand, Barbara; Peters, Annette; Borchini, Rossana; Jørgensen, Torben; Söderberg, Stefan; Sans, Susana; Tunstall‐Pedoe, Hugh; Kuulasmaa, Kari; Renné, Thomas; Lackner, Karl J.; Worster, Andrew; Body, Richard; Ekelund, Ulf; Kavsak, Peter A.; Keller, Till; Lindahl, Bertil; Wild, Philipp S.; Giannitsis, Evangelos; Than, Martin; Cullen, Louise; Mills, Nicholas L; Müeller, Christian; Zeller, Tanja; Westermann, Dirk; Blankenberg, Stefan

doi:10.1056/nejmoa1803377

Cited by 270 publications

(189 citation statements)

References 25 publications

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“…Studies on the biological variation of cTns have emphasized a very high individuality of these biomarkers, expressed as a low index of individuality, confirming major limitations for the use of population-based reference limits [16]. Accordingly, only serial testing in the same individual allows for the discrimination of pathophysiological mechanisms of cTn release [17]. Scrutiny of cTn release kinetics in blood is essential to differentiate acute from chronic myocardial damage and may help to understand the characteristics of underlying processes associated with cTn release [13].…”

Section: The Post-analytical Phase: Improving Results' Interpretationmentioning

confidence: 99%

Laboratory-related issues in the measurement of cardiac troponins with highly sensitive assays

Krintus

Panteghini

2020

Clinical Chemistry and Laboratory Medicine (CCLM)

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A number of assay-related issues can affect the performance of cardiac troponin (cTn) measurement in everyday practice. In this respect, it is vital that all information on cTn assays is known and that the performance characteristics of assays are objectively assessed and adequately described. The advent of the latest generation of more sensitive cTn assays has heralded a new wave of information about low concentrations of cTn in blood. These recent generation assays have improved analytical sensitivity and corresponding performance at low cTn concentrations when compared to their predecessors, providing a convincing goal for laboratory medicine in helping clinicians in the diagnosis of acute myocardial infarction. Crucial to the clinical utility of highly sensitive cTn assays is the laboratorians’ role in closely scrutinizing proposed assays and defining their value in relation to available evidence. Analytical, as well as pre-analytical and post-analytical, aspects must be documented. In this review, we describe what laboratory professionals should know about their cTn assay performance characteristics and the pre-analytical prerequisites for robustness to ensure optimal post-analytical reporting.

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Section: The Post-analytical Phase: Improving Results' Interpretationmentioning

confidence: 99%

Laboratory-related issues in the measurement of cardiac troponins with highly sensitive assays

Krintus

Panteghini

2020

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…Both high-sensitivity CRP (hs-CRP) and CRP can be used for the detection of an acute phase response. Finally, both cardiac troponin and high-sensitivity cardiac troponin (hs-cTn) can identify myocardial injury with hs-cTn superior for identifying low-risk individuals [10]. Importantly, survivors of COVID-19 at admission had a median hs-cTnI level of 3 ng/L [1]; as such low hs-cTn levels, in combination with other algorithms, may be helpful in this setting [1,3,10].…”

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confidence: 99%

Clinical chemistry tests for patients with COVID-19 – important caveats for interpretation

Kavsak

Wit

Worster

2020

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…However, there are huge variations in proportion of patients with acute myocardial infarction reported in previously published studies, ranging from 4.5% to 43.8%. [18] We were unable to complete 30-day follow-up for approximately 4% of patients. Given that a low proportion of patients suffered MACE and such a small number of patients were lost to follow-up, these patients are unlikely to influence the results of the study.…”

Section: Discussionmentioning

confidence: 98%

Use of conventional cardiac troponin assay for diagnosis of non-ST-elevation myocardial infarction: ‘The Ottawa Troponin Pathway’

Thiruganasambandamoorthy

Stiell

Chaudry

et al. 2020

PLoS ONE

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Background Serial conventional cardiac troponin (cTn) measurements 6-9 hours apart are recommended for non-ST-elevation MI (NSTEMI) diagnosis. We sought to develop a pathway with 3-hour changes for major adverse cardiac event (MACE) identification and assess the added value of the HEART [History, Electrocardiogram (ECG), Age, Risk factors, Troponin] score to the pathway. Methods We prospectively enrolled adults with NSTEMI symptoms at two-large emergency departments (EDs) over 32-months. Patients with STEMI, unstable angina and one cTn were excluded. We collected baseline characteristics, Siemens Vista conventional cTnI at 0, 3 or 6-hours after ED presentation; HEART score predictors; disposition and ED length of stay (LOS). Adjudicated primary outcome was 15-day MACE (acute MI, revascularization, or death due to cardiac ischemia/unknown cause). We analyzed multiples of 99th percentile cutoff cTnI values (45, 100 and 250ng/L). Results 1,683 patients (mean age 64.7 years; 55.3% female; median LOS 7-hours; 88 patients with 15-day MACE) were included. 1,346 (80.0%) patients with both cTnI�45 ng/L; and 155 (9.2%) of the 213 patients with one value�100ng/L but both<250ng/L or �20% change did not suffer MACE. Among 124 patients (7.4%) with one of the two values>45ng/L but<100ng/L based on 3 or 6-hour cTnI, one patient with absolute change<10ng/L and 6 of the 19 patients with�20ng/L were diagnosed with NSTEMI (patients with Δ10-19ng/L between first and second cTnI had third one at 6-hours). Based on the results, we developed the Ottawa Troponin Pathway (OTP) with a 98.9% sensitivity (95% CI 93.8-100%) and 94.6%

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Application of High-Sensitivity Troponin in Suspected Myocardial Infarction

Cited by 270 publications

References 25 publications

Laboratory-related issues in the measurement of cardiac troponins with highly sensitive assays

Laboratory-related issues in the measurement of cardiac troponins with highly sensitive assays

Clinical chemistry tests for patients with COVID-19 – important caveats for interpretation

Use of conventional cardiac troponin assay for diagnosis of non-ST-elevation myocardial infarction: ‘The Ottawa Troponin Pathway’

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