High-Sensitivity Troponin T Testing: Consequences on Daily Clinical Practice and Effects on Diagnosis of Myocardial Infarction

Zachoval, Christian; Dolscheid‐Pommerich, Ramona; Graeff, Ingo; Goldschmidt, Bernd; Grigull, Andreas; Stoffel‐Wagner, Birgit; Nickenig, Georg; Zimmer, Sebastian

doi:10.3390/jcm9030775

Cited by 6 publications

(4 citation statements)

References 47 publications

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“…Introduction of new high sensitivity troponin assays for the purpose of solving that problem, by lowering the limit of detection and thus, helping in more rapid exclusion of MI than old conventional troponin assays. 12 Conventional troponins have revolutionized the management of suspected NSTEMI, including risk stratification. A cutoff value for troponins at the 99 th percentile has been recommended, as value beyond it is associated with adverse outcome and need of early invasive strategy.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Rapid Kit Based Conventional Troponin-T and High Sensitive Troponin-I Chemiluminescence Immunoassay Technique in Patients Presenting With Typical Chest Pain

Nadeem,

Khan,

Nazish Saeed

et al. 2022

Pak Heart J

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Objectives: Cardiac troponins are keystone in diagnosing and risk stratification of patients with suspected non-ST elevation myocardial infarction (NSTEMI). We aimed to analyze and compare hs-TropI and c-TropT in patients presenting with typical chest pain to emergency department (ER) in our institute. Methodology: Consecutive patients between ages of 20 to 80 years of both genders presenting with typical chest pain for more than 30 minutes were included in the study. Patients with ST elevation on ECG, acute left ventricular failure (LVF), sepsis and chronic kidney disease were excluded from the study. Results: Hundred patients were analyzed presenting with typical chest pain. Mean age of participants was 50+10.75 years. 72 (72%) patients presented with early (<4hrs) chest pain and 28 (28 %) with late ≥4hrs) chest pain. On ECG 57 (57%) patients showed T-wave inversion, 33 (33%) had ST depression and 1 (1%) had left bundle branch block (LBBB). Sensitivity and negative predictive value for hs-TropI was found to be 87% and 94% respectively, while for c-TropT these were 72% and 96%, respectively. Conclusion: This study demonstrated that positive predictive value of c-TropT (conventional troponin T) in diagnosing NSTEMI is low as compared to hs-Trop I (high sensitive troponin I). Thus, it is recommended that lab-based hs-TropI should be preferred over kit-based c-TropT for screening or diagnostic purposes, even though the latter is cost effective and takes less time.

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Section: Discussionmentioning

confidence: 99%

Comparison Between Rapid Kit Based Conventional Troponin-T and High Sensitive Troponin-I Chemiluminescence Immunoassay Technique in Patients Presenting With Typical Chest Pain

Nadeem,

Khan,

Nazish Saeed

et al. 2022

Pak Heart J

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“…Literature has confirmed that the increase of cTnT is a strong risk factor of recent adverse cardiovascular events and is also applicable to patients undergoing cardiac intervention and surgery [ 31 – 34 ]. As reported, cTnT before percutaneous coronary intervention can provide better predictive value for postoperative outcomes [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG

Shan

et al. 2020

BMC Cardiovasc Disord

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Background Preoperative risk evaluation systems are significant and important to the allocation of medical resources and the communication between doctors and patients. The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is widely used in clinical practice. Cardiac troponin T (cTnT) can specifically and accurately reflect myocardial injury. Whether EuroSCORE II can improve the predictive power after integrating with cTnT is still unclear. This study was a retrospective single center study designed to assess the predictive ability of EuroSCORE II integrated with cTnT for patients undergoing isolated off-pump coronary artery bypass grafting (OPCABG). Methods This retrospective and observational cohort study included 1887 patients who underwent first isolated OPCABG. cTnT was detected within 48 h before operation in each patient. According to myocardial injury, patients were divided by cTnT into 4 stages. A new risk evaluation system was created through logistic regression with EuroSCORE II and myocardial injury classification as covariates. Then the two risk evaluation systems were comparatively assessed by regression analysis, receiver operator characteristic curves, net reclassification index, Bland–Altman plots and decision curve analysis. Results There were 43 in-hospital deaths, with a mortality of 2.30% (43/1887). The logistic regression analysis showed that preoperative myocardial injury classification was a significant risk factor for in-hospital mortality in both total cohort (OR 1.491, 95%CI 1.049–2.119) and subsets (OR 1.761, 95%CI 1.102–2.814). The new risk evaluation system has higher calibration and discrimination power than EuroSCORE II, both for overall cohort and subsets. Especially, the new system has obvious advantages in discrimination power in the subset of acute myocardial infarction (AUC 0.813 vs. 0.772, 0.906 vs. 0.841, and 0.715 vs. 0.646, respectively). Conclusions Both myocardial injury classification and EuroSCORE II are independent risk factors of in-hospital mortality in OPCABG patients. The new risk evaluation system has higher predictive ability than EuroSCORE II, especially in patients with a recent history of AMI.

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“…Five retrieved studies (n = 504,123) met our inclusion criteria and were included in the final analysis [34][35][36][37][38] . All of the studies were observational in design.…”

Section: Study Characteristics and Qualitymentioning

confidence: 99%

Outcomes and Management When Using High-sensitivity Versus Conventional Cardiac Troponin in Patients With Chest Pain: A Meta-analysis

Pilapil,

Cheng,

Alad

et al. 2023

Preprint

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BackgroundCardiac troponin (cTn) measurement is pivotal in diagnosing and managing chest pain. High-sensitivity cTn (hs-cTn) assays are slowly supplanting conventional cardiac troponin (c-cTn) use, allowing earlier identification of high-risk patients and diagnosis of myocardial infarction (MI). This improved sensitivity is said to come at the cost of reduced specificity for MI. However, there is a paucity of data regarding the exact impact of this change in patient management and outcomes.ObjectivesTo compare outcomes and management of patients with chest pain when using hs-cTn versus c-cTn.MethodsWe conducted a systematic search of studies in all languages across various databases. Inclusion criteria for studies were (1) observational or randomized trials, (2) included adult patients presenting with chest pain, (3) use of hs-cTn or c-cTn in diagnosis, (3) reported data on any of the pre-defined outcomes. The primary outcome was all-cause mortality and secondary outcomes were major adverse cardiovascular events (MACE), MI following index admission, coronary angiography, and revascularization. Study quality was appraised using the Cochrane Tool for Assessing Risk of Bias for randomized trials and the Newcastle-Ottawa Quality Assessment scale for observational studies. Outcomes were analyzed using Review Manager (RevMan) 5.3, employing Mantel-Haenszel analysis of random effects to compute for relative risk and odds ratio.ResultsPooled analysis from 5 studies showed that among patients with chest pain, those for whom hs-cTn over c-cTn was used had no difference in all-cause mortality (RR 1.01, 95% CI 0.92-1.12, p=0.82, I2=0%), a significant decrease in MI (RR 0.74, 95% CI 0.63-0.87, p=0.0003) and a trend towards increase in MACE (RR 1.08, 95% CI 1.00-1.16, p=0.04, I2=0%). They were more likely to undergo coronary angiogram (OR 1.52, 95% CI 1.02-2.28, p=0.04) and revascularization (OR 1.34, 95% CI 1.03-1.75, p=0.03).ConclusionUse of hs-cTn over conventional cTn led to higher rates of coronary angiography and revascularization. While there was significant reduction in myocardial infarction, there was no reduction in all-cause mortality and even a trends towards increased MACE.

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High-Sensitivity Troponin T Testing: Consequences on Daily Clinical Practice and Effects on Diagnosis of Myocardial Infarction

Cited by 6 publications

References 47 publications

Comparison Between Rapid Kit Based Conventional Troponin-T and High Sensitive Troponin-I Chemiluminescence Immunoassay Technique in Patients Presenting With Typical Chest Pain

Comparison Between Rapid Kit Based Conventional Troponin-T and High Sensitive Troponin-I Chemiluminescence Immunoassay Technique in Patients Presenting With Typical Chest Pain

Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG

Outcomes and Management When Using High-sensitivity Versus Conventional Cardiac Troponin in Patients With Chest Pain: A Meta-analysis

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