Plasma 99th Percentile Reference Limits for Cardiac Troponin and Creatine Kinase MB Mass for Use with European Society of Cardiology/American College of Cardiology Consensus Recommendations

Abstract

Background: The European Society of Cardiology/ American College of Cardiology (ESC/ACC) consensus document for definition of myocardial infarction (MI)is predicated on increased cardiac troponin or creatine kinase (CK) MB mass above the 99th percentile reference limit. The purpose of this study was to determine the plasma (heparin) 99th percentile reference limits for the leading in vitro diagnostic cardiac troponin and CKMB mass assays. Methods: Blood (heparin plasma) was obtained from healthy adults (n ‫؍‬ 696; age range, 18 -84 years) stratified by gender and ethnicity. Cardiac troponin I (cTnI) and T (cTnT) and CKMB mass concentrations were measured by eight assays. Reference limits were determined by nonparametric statistical analysis. Results: Two cTnI assays demonstrated at least a 1.2-to 2.5-fold higher 99th percentile for males vs females, with the mean concentrations significantly higher for males (P <0.05). Two cTnI assays also demonstrated a 1.1-to 2.8-fold higher 99th percentile for blacks vs Caucasians, with the mean concentrations significantly higher for blacks (P ‫؍‬ 0.05). There was a 13-fold variance between the lowest measured 99th percentile (0.06 g/L) and the highest (0.8 g/L). All CKMB assays demonstrated a 1.2-to 2.6-fold higher 99th percentile for males vs females, with mean concentrations signifi-

Health Outcomes Categorized by Current and Previous Definitions of Acute Myocardial Infarction in an Unselected Cohort of Troponin-Naïve Emergency Department Patients

“…Evidence from an unbiased population is essential to allow for continued epidemiologic surveillance of populations. Furthermore, our retrospective measurement of cTnI also allows a comparison of different cTnI concentrations grouped according to published cutoff values (7 ).…”

Evaluation of the effect size of low-density lipoprotein, high-density lipoprotein, and triglyceride levels of patients detected to have high troponin

“…[3] Miyokard enfarktüsü tanısının konulmasında troponin de¤erinin 0.014 ng/mL'nin üstünde olması en önemli parametrelerdendir. [4][5][6] Miyokard enfarktüsü geçiren hastaların ço¤unda düük yo¤unluklu lipoprotein (LDL) ve yüksek yo¤unluklu lipoprotein (HDL) de¤erlerine ait sorunlarda bulunabilmektedir. [7,8] Bu bilgilere dayanarak, troponin de¤eri 0.014 ng/mL'nin üstünde ve altında olan olguların LDL ve HDL de¤erleri arasında fark olup/olmadı¤ının gösterilmesinin amaçlandı¤ı bu çalıma planlandı.…”

“…Veriler troponin düzeyinin 0.014 ng/mL'nin [4][5][6] altında veya üstünde olmasına göre iki gruba ayrıldı. Olguların LDL, HDL ve trigliserid de¤erlerinin troponin gruplarına göre normal da¤ılıma uygunlu¤u Shapiro Wilk testiyle de¤erlendirildi.…”

Acurácia dos escores GRACE e TIMI na predição da gravidade angiográfica da síndrome coronariana aguda

“…The inclusion criterion in that registry has been defined as typical chest discomfort at rest for the past 48 hours, associated with at least one of the following characteristics: 1) positive myocardial necrosis marker, defined as troponin T ≥ 0.01 ug/L or troponin I > 0.034 µg/L, corresponding to values over the 99 th percentile 8,9 ; 2) ischemic electrocardiographic changes, consisting of T wave inversion (≥ 0.1 mV) or transient STsegment depression (≥ 0.05 mV); 3) coronary artery disease previously documented, defined by a history of myocardial infarction or previous angiography showing coronary artery obstruction ≥ 50%. For the current analysis, of the patients included in Resca, those undergoing invasive coronary angiography during hospitalization were selected.…”

“…Elevation of the myocardial necrosis marker as a component of the scores was defined as troponin T ≥ 0.01 ug/L or troponin I ≥ 0.034 µg/L, that is, above the 99 th percentile 8,9 . Killip classification 10 has also been applied to patients with unstable angina so that the GRACE score could be calculated.…”