Author + information
- William Parsonage,
- Louise Cullen,
- Jaimi Greenslade,
- Jill Tate,
- Jacobus Ungerer,
- Christopher Hammett,
- Carel Pretorius,
- Kevin Chu and
- Anthony Brown
The performance of highly sensitive troponin assays in the early detection of acute myocardial infarction (AMI) in patients presenting to the emergency department (ED) with chest pain is assay-dependent. The aim was to compare the diagnostic accuracy for AMI of highly sensitive troponin I (hsTnl) and T (hsTnT) at zero and two hours after ED arrival.
A prospective study recruited patients with symptoms of possible acute coronary syndrome (ACS). Bloods were sampled at zero and two hours after ED arrival. The diagnostic accuracy of hsTnl (ARCHITECT High Sensitive STAT Troponin-I assay, Abbott Laboratories) and hsTnT (TroponinT hs CS Elecsys, Roche Diagnostics) were compared using their 99th percentile cut-off of 26.2ng/L and 14ng/L respectively. The reference standard was the diagnosis at presentation as adjudicated by two independent cardiologists following the patients' hospital discharge and using all available clinical data including cTnl at 0 and >6hrs following presentation. The results of the investigational assays were not used for adjudication of endpoints.
737 patients [male 60.1%, median (IQR) age 54 (44–65) years] were recruited including 51 (6.9%) with AMI. 93 (12.6%) had an elevated hsTnl at either zero or two hours while 128 (17.4%) had an elevated hsTnT. At zero and two hours, the AUCs for hsTnT were 0.94 and 0.96 respectively and the AUC for hsTnl were 0.97 and 0.98 respectively. There was no difference in the sensitivity of hsTnT and hsTnl at zero (0.86 vs 0.88, p=1.0) and zero or two hours (0.95 vs 0.92, p=1.0). However, the specificity of hsTnl was higher than hsTnT at zero hours (0.95 vs 0.89, p<0.01) and at zero or two hours (0.93 vs 0.88, p<0.01).
The diagnostic performance of hsTnl and hsTnT showed that they were equally sensitive for rule-out of AMI at two hours. hsTnl was more specific for the early diagnosis of AMI.
Moderated Poster Contributions
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: High Sensitivity Troponins: New Insights
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1302M-198
- 2013 American College of Cardiology Foundation