Journal article
High sensitive cardiac troponin T: Testing the test.
- Haider DG Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland. Electronic address: dominikhaider2003@yahoo.de.
- Klemenz T Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
- Fiedler GM Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Switzerland.
- Nakas CT Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Switzerland; Laboratory of Biometry, University of Thessaly, Phytokou Street, 38446 Volos, Greece.
- Exadaktylos AK Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
- Leichtle AB Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Switzerland.
- 2016-11-27
Published in:
- International journal of cardiology. - 2017
Acute myocardial infarction
Assay
hs-TnT
Aged
Aged, 80 and over
Biomarkers
Female
Humans
Male
Middle Aged
Myocardial Infarction
Predictive Value of Tests
ROC Curve
Retrospective Studies
Switzerland
Troponin T
English
BACKGROUND
High sensitive cardiac troponin T (hs-TnT) found its way into everyday clinical routine to diagnose acute myocardial infarction (AMI). However, its levels vary considerably based on the underlying pathophysiology of the patients. Hence we sought to test the applicability of the currently only available hs-TnT assay (Roche Diagnostics, Switzerland) to diagnose acute myocardial infarction.
METHODS AND PATIENTS
Retrospectively, we analyzed the hs-TnT results of 1573 patients admitted to a level A university hospital emergency department. Overall 323 patients had an acute cardiac event defined as Non-ST Elevated Myocardial Infarction (NSTEMI) and 286 patients had a ST-Elevated Myocardial Infarction (STEMI). 964 patients served as controls, consisting of patients with other cardiac and non-cardiac morbidity.
RESULTS
The sensitivity of hs-TnT for detecting an acute cardiac event was more than 92% overall. The specificity varied around 35% depending on the respective patient cohort. ROC curve analysis of the initial hs-TnT results showed that the AUC in total cardiac events (STEMI and NSTEMI) was 0.81. Detailed analysis resulted in an AUC of 0.79 in NSTEMI and 0.84 in STEMI patients detected via the initial hs-TnT. We further tested the ESC algorithm for detecting NSTEMI and obtained a sensitivity of about 83%, while 43% of all non-NSTEMIs are classified as NSTEMIs.
CONCLUSION
We show that the specificity of hs-TnT for AMI is very low and conclude that the current assay including its delta values represents myocardial damage of any origin. This damage alone does not substantiate an AMI diagnosis even when international algorithms are applied.
High sensitive cardiac troponin T (hs-TnT) found its way into everyday clinical routine to diagnose acute myocardial infarction (AMI). However, its levels vary considerably based on the underlying pathophysiology of the patients. Hence we sought to test the applicability of the currently only available hs-TnT assay (Roche Diagnostics, Switzerland) to diagnose acute myocardial infarction.
METHODS AND PATIENTS
Retrospectively, we analyzed the hs-TnT results of 1573 patients admitted to a level A university hospital emergency department. Overall 323 patients had an acute cardiac event defined as Non-ST Elevated Myocardial Infarction (NSTEMI) and 286 patients had a ST-Elevated Myocardial Infarction (STEMI). 964 patients served as controls, consisting of patients with other cardiac and non-cardiac morbidity.
RESULTS
The sensitivity of hs-TnT for detecting an acute cardiac event was more than 92% overall. The specificity varied around 35% depending on the respective patient cohort. ROC curve analysis of the initial hs-TnT results showed that the AUC in total cardiac events (STEMI and NSTEMI) was 0.81. Detailed analysis resulted in an AUC of 0.79 in NSTEMI and 0.84 in STEMI patients detected via the initial hs-TnT. We further tested the ESC algorithm for detecting NSTEMI and obtained a sensitivity of about 83%, while 43% of all non-NSTEMIs are classified as NSTEMIs.
CONCLUSION
We show that the specificity of hs-TnT for AMI is very low and conclude that the current assay including its delta values represents myocardial damage of any origin. This damage alone does not substantiate an AMI diagnosis even when international algorithms are applied.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.ijcard.2016.10.043
- PMID 27888755
- Persistent URL
- https://sonar.ch/global/documents/157029
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