Lehmacher, Jonas;
Sörensen, Nils Arne;
Twerenbold, Raphael;
Goßling, Alina;
Haller, Paul Michael;
Hartikainen, Tau Sarra;
Schock, Alina;
Toprak, Betül;
Zeller, Tanja;
Westermann, Dirk;
Neumann, Johannes Tobias
Diagnostic and prognostic value of the sex-specific 99th percentile of four high-sensitivity cardiac troponin assays in patients with suspected myocardial infarction
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Medientyp:
E-Artikel
Titel:
Diagnostic and prognostic value of the sex-specific 99th percentile of four high-sensitivity cardiac troponin assays in patients with suspected myocardial infarction
Beteiligte:
Lehmacher, Jonas;
Sörensen, Nils Arne;
Twerenbold, Raphael;
Goßling, Alina;
Haller, Paul Michael;
Hartikainen, Tau Sarra;
Schock, Alina;
Toprak, Betül;
Zeller, Tanja;
Westermann, Dirk;
Neumann, Johannes Tobias
Erschienen:
Oxford University Press (OUP), 2024
Erschienen in:
European Heart Journal: Acute Cardiovascular Care, 13 (2024) 1, Seite 3-12
Beschreibung:
<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Aims</jats:title>
<jats:p>High-sensitivity cardiac troponin (hs-cTn) assays are used for detection of myocardial infarction (MI). Ninety-ninth percentiles show wide inter-assay variation. The use of sex-specific cut-offs is recommended as definitory cut-off for MI. We compared diagnostic performance and prognostic value of sex-specific 99th percentiles of four hs-cTn assays in patients with suspected MI.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods and results</jats:title>
<jats:p>Concentrations of four hs-cTn assays were measured at presentation and after 3 h in patients with suspected MI. Final diagnoses were adjudicated according to the 4th Universal Definition of MI. Unisex and sex-specific 99th percentiles were evaluated as diagnostic cut-offs following the ESC 0/3 h algorithm. These cut-offs were used in Cox-regression analyses to investigate the association with a composite endpoint of MI, revascularization, cardiac rehospitalization, and death. Non-ST-elevation MI was diagnosed in 368 of 2718 patients. Applying the unisex 99th percentile, Elecsys hs-cTnT provided highest negative predictive value (NPV) of 99.7 and a positive predictive value (PPV) of 75.9. The analysed hs-cTnI assays showed slightly lower NPVs and comparable PPVs [Architect (NPV 98.0, PPV of 71.4); Atellica (NPV 97.7, PPV of 76.1); Pathfast (NPV 97.7, PPV of 66.6)]. Application of sex-specific 99th percentiles did not significantly affect diagnostic performance. Concentrations above 99th percentile were independent predictors for impaired long-term outcome (hazard ratios 1.2–1.5, P &lt; 0.001).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>We describe a good diagnostic accuracy of four hs-cTn assays using the assay-specific 99th percentile for detection of MI. Application of sex-specific 99th percentiles did neither affect diagnostic performance nor prognostic value significantly. Finally, values above the 99th percentile were associated with poor long-term outcome.</jats:p>
</jats:sec>