How to use high-sensitivity cardiac troponins in acute cardiac care

Thygesen, Kristian; Mair, Johannes; Giannitsis, Evangelos; Müeller, Christian; Lindahl, Bertil; Blankenberg, Stefan; Huber, Kurt; Plebani, Mario; Biasucci, Luigi M.; Tubaro, Marco; Collinson, Paul; Venge, Per; Hasin, Yonathan; Galvani, Marcello; Köenig, Wolfgang; Hamm, Christian W.; Alpert, Joseph S.; Katus, Hugo A.; Jaffe, Allan S.

doi:10.1093/eurheartj/ehs154

Cited by 684 publications

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“…Nor do the 2012 ESC guidelines [38] or the Third Universal Definition of Myocardial Infarction [3] take into account the issue of the definition of the reference population for calculating the 99th URL.…”

Section: Agementioning

confidence: 99%

“…This issue is of great clinical relevance in view of the fact in ED patients an enormous number of cardiac and even extra-cardiac clinical conditions are associated with cTnI or cTnT levels higher than 99th URL [1][2][3]38]. Indeed, according to Giannitsis and Katus [40], only about 40% of patients admitted to ED with at least one troponin value over the 99th URL measured by highly sensitive methods actually has AMI.…”

Section: Agementioning

confidence: 99%

“…It is widely believed that biological variations in cTnI and cTnT might affect the accurate determination of rises and falls in biomarker values after acute myocardial injury [38,60]. As cTn has a low individuality index [60], a serial change in hs-TnI or hs-cTnI levels (using 99th percentile diagnostic cut-off) 0 to 3 h after admission may facilitate an early diagnosis of AMI [61].…”

Section: Biological Variationmentioning

confidence: 99%

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The 99th percentile of reference population for cTnI and cTnT assay: methodology, pathophysiology and clinical implications

Clerico

Zaninotto

Ripoli

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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According to recent international guidelines, including the 2012 Third Universal Definiton of Myocardial Infarction by the Joint ESC/ACCF/AHA/WHF Task Force, an increase in cardiac troponin (cTn) levels over the 99th percentile upper reference limit (99th URL) should be considered clinically relevant, this cut-off being measured with an imprecision ≤10 CV%. In theory 99th URL values strongly depend not only on demographic and physiological variables (i.e. criteria for considering the reference population "healthy"), but also on the analytical performance of cTn methods and mathematical algorithms used for the calculation. The aim of the present article was therefore to review the methodological and pathophysiological factors affecting the evaluation and calculation of the 99th URL for cTn assay. The critical analysis made showed that no uniform procedure is followed, and nor have experts or regulatory bodies provided uniform guidelines for researchers or cTn assays manufacturers as an aid in "their quest to define normality". In particular, little attention has been paid to the way in which a healthy reference population is to be selected, or the criteria for calculating the 99th URL value for cTn assays, thus highlighting the need for international recommendations not only for demographic and physiological variables criteria for defining a healthy reference population, but also for calculating mathematical algorithms for establishing/ calculating clinical decision values. An expert consensus group, comprising laboratory and clinical scientists, biomedical statisticians, industrial and regulatory representatives, should be responsible for drawing up these guidelines.

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Section: Agementioning

confidence: 99%

Section: Agementioning

confidence: 99%

Section: Biological Variationmentioning

confidence: 99%

See 1 more Smart Citation

The 99th percentile of reference population for cTnI and cTnT assay: methodology, pathophysiology and clinical implications

Clerico

Zaninotto

Ripoli

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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show abstract

“…Major advances have recently been achieved by the development of more sensitive cardiac troponin assays. [6][7][8][9][10][11][12][13][14][15] High-sensitivity cardiac troponin assays, which allow measurement of even low concentrations of cardiac troponin with high precision, have been shown to largely overcome the sensitivity deficit of conventional cardiac troponin assays within the first hours of presentation in the diagnosis of acute MI. [6][7][8][9][10][11][12][13][14][15] These studies have consistently shown that the classic diagnostic interpretation of cardiac troponin as a dichotomous variable (troponinnegative and troponin-positive) no longer seems appropriate, because the positive predictive value for acute MI of being troponin-positive was only about 50%.…”

mentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13][14][15] High-sensitivity cardiac troponin assays, which allow measurement of even low concentrations of cardiac troponin with high precision, have been shown to largely overcome the sensitivity deficit of conventional cardiac troponin assays within the first hours of presentation in the diagnosis of acute MI. [6][7][8][9][10][11][12][13][14][15] These studies have consistently shown that the classic diagnostic interpretation of cardiac troponin as a dichotomous variable (troponinnegative and troponin-positive) no longer seems appropriate, because the positive predictive value for acute MI of being troponin-positive was only about 50%. [6][7][8][9][10][11][12][13][14][15] The best way to interpret and Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay Background: We aimed to prospectively valid ate a novel 1hour algorithm using high sensitivity cardiac troponin T measurement for early ruleout and rulein of acute myocardial infarction (MI).…”

mentioning

confidence: 99%