Brief Rapid ReportHigh-Sensitivity Cardiac Troponin Risk Cutoffs for Acute Cardiac Outcomes at Emergency Department Presentation
Section snippets
Study design and population
This study was a multicentre prospective cohort study conducted across a North American city (Hamilton, Ontario; study: Optimum Troponin Cutoffs for ACS in the ED [Rule-Out Myocardial Infarction-3 (ROMI-3)]; Clinicaltrials.gov: NCT01994577) whose primary outcome measure was a composite cardiac outcome after ED presentation. We followed the Standards for the Reporting of Diagnostic Accuracy Studies (STARD) guideline for our initial reporting of diagnostic accuracy in this population (n = 1137),
Results
The prevalence for the composite outcome (24.0%; 95% CI, 21.3-27.0) was significantly higher than for MI (11.7%; 95% CI, 9.8-13.9) in the study population (average [SD] age = 66.7 [16.5]; n = 1137). The diagnostic accuracy of hs-cTnI at presentation for MI (AUC, 0.90; 95% CI, 0.87-0.93) was significantly higher than hs-cTnT (AUC, 0.86; 95% CI, 0.83-0.89; P < 0.001; Fig. 1A). However, there was no difference in diagnostic performance between hs-cTnI and hs-cTnT for the remaining individual
Discussion
There are a couple of noteworthy findings from the present analyses. First, the performance between hs-cTnI and hs-cTnT laboratory tests are equivalent when assessing important cardiac outcomes whose diagnosis is not dependent on a cardiac troponin concentration exceeding the 99th percentile. The incorporation bias that is present when evaluating new, more analytically sensitive versions of cardiac troponin tests for the diagnosis of MI extends further to whether cardiac troponin I or cardiac
Conclusions
Patients who present to the ED with undetectable and low hs-cTn concentrations below 14 ng/L are at lower risk for an acute cardiac outcome compared with those who present with concentrations above the proposed North American 99th percentile, with hs-cTnT ≥ 20 ng/L and hs-cTnI ≥ 31 ng/L representing a high-risk group. Hence, application of risk cutoffs for hs-cTn at ED presentation can better determine patient risk for an adverse cardiac event compared with using one overall 99th-percentile
Acknowledgements
This study is registered at Clinicaltrials.gov: NCT01994577.
Funding Sources
This study was supported by a Canadian Institutes of Health Research grant with reagent support from Roche Diagnostics and Abbott Diagnostics.
Disclosures
Dr Kavsak has received grants/reagents/consultant/advisor/honoraria from Abbott Laboratories, Abbott Point of Care, Abbott Diagnostics Division Canada, Beckman Coulter, Ortho Clinical Diagnostics, Randox Laboratories, Roche Diagnostics and Siemens Healthcare Diagnostics. McMaster University has filed patents with Dr Kavsak listed as an inventor in the acute cardiovascular biomarker field. The remaining authors have no conflicts of interest to disclose.
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2020, International Journal of CardiologyCitation Excerpt :All adjudicators were blinded to the research hs-cTn results [7,9,10]. MI was diagnosed consistent with the Third Universal Definition of MI when at least one cTnI concentration (from all clinically available cTnI results from a sensitive assay) was above the 99th-percentile with a significant rise/fall [7,9,10]. MIs after the index presentation (i.e., 7 h after presentation) until 7-days post presentation were also diagnosed using electrocardiogram findings indicative of new cardiac ischemia.
High-sensitivity-cardiac troponin for accelerated diagnosis of acute myocardial infarction: A systematic review and meta-analysis
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2019, Canadian Journal of CardiologyEvaluation of the Siemens ADVIA Centaur high-sensitivity cardiac troponin I assay in serum
2018, Clinica Chimica ActaCitation Excerpt :The findings that the Siemens hs-cTnI assay yields higher results compared to both the Abbott and Beckman hs-cTnI assays is in agreement with higher sex-specific 99th percentiles and higher cutoffs in the 0/1 h or 0/2 h protocols when using the Siemens hs-cTnI assay [4–6]. Accordingly, it is important that assay specific cutoffs be employed when using the Siemens hs-cTnI assay and not a common number that as has been suggested for hs-cTnT and some hs-cTnI assays [16,17]. Our study also has some limitations, mainly in the fact that there were a limited number of aliquots available for measurement with the Siemens hs-cTnI assay from the 2003 ED population.
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These authors contributed equally to this work.