Cardiac Troponin – High-Sensitivity Troponin Assays
for Earlier Diagnosis of Myocardial Infarctions
ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-segment Elevation
- The 99th percentile for cTn is the single decision limit for both AMI and risk in patients presenting with symptoms of cardiac ischemia (either cTnI or cTnT can be used)
- Labs may establish a decision limit for each biomarker based on a normal, healthy population with no evidence of heart disease or use the manufacturer’s established value.
- Imprecision (CV) at the 99th percentile decision point should be ≤ 10%
- Small myocardial injury can be detected using sensitive assay or imaging
- Rising or falling kinetics helps discriminate acute from chronic illness
European Heart Journal (2016) 37, 267-315
https://academic.oup.com/eurheartj/article/37/3/267/2466099
IFCC Task Force Recommendations
Supports 99th Percentile
- 99th percentile cut-off universally endorsed
- Determined in a healthy population
- Derived from peer-reviewed literature, or manufacturer
- Analytical precision should be ≤ 10% CV
Defines High-Sensitivity Troponin
- High-sensitivity assays (hs-assays) should measure cTn > limit of detection (LoD) in ≥ 50% of the healthy subjects used to determine the 99th percentile
- Results reported in ng/L or pg/mL instead of µg/L (gives whole number values instead of decimals for easier interpretation)
AHA/ACC Guidelines - Cardiac Troponin Highlights
- 99th percentile for cardiac troponin is appropriate cutoff for considering myocardial necrosis
- For contemporary assays, serial cardiac troponin levels should be measured at presentation and 3 to 6 hours after symptom onset in all patients who present with chest pain symptoms. This identifies a rising and/or falling pattern
- In evaluating serial changes, absolute changes appear to have a significantly higher diagnostic accuracy for AMI than relative changes
http://circ.ahajournals.org/content/130/25/e344
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