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  4. Cardiac Assays
  5. Cardiac Troponin

Cardiac Troponin

for Earlier Diagnosis of Myocardial Infarctions

Cardiac Troponin
 
Bizle İletişime Geçin

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
 

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)

IFCC Task Force on Clinical Applications of Cardiac Biomarkers

 

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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