{"id":654,"date":"2019-02-07T18:46:51","date_gmt":"2019-02-07T18:46:51","guid":{"rendered":"http:\/\/clinicalbiochemistry.net\/?page_id=654"},"modified":"2019-02-07T18:46:52","modified_gmt":"2019-02-07T18:46:52","slug":"does-troponin-cut-off-matter","status":"publish","type":"page","link":"http:\/\/clinicalbiochemistry.net\/?page_id=654","title":{"rendered":"Does Troponin Cut-off Matter?"},"content":{"rendered":"\n

Body, R., McDowell, G.<\/strong>, Carley, S., Ferguson, J. & Mackway-Jones, K. (2010) \u2018Diagnosing acute myocardial infarction with troponins: how low can you go?\u2019 Emerg Med J<\/em>. 27 pp. 292-296.<\/p>\n\n\n\n

Background:<\/strong>Recent consensus guidelines state that acute myocardial infarction (AMI) may be diagnosed in the context of a troponin rise above the 99th percentile of the upper reference limit (URL) with the optimal imprecision of the assay (coefficient of variation, CV) being <10%. However, at the 99th percentile, modern assays do not have a CV <10%. <\/p>\n\n\n\n

Objective:<\/strong>The authors compared the prognostic implications of placing the diagnostic troponin cut-off at the 99th percentile and at the lowest concentration with a CV <10% (functional sensitivity). <\/p>\n\n\n\n

Methods:<\/strong>The authors prospectively recruited 804 patients presenting to the Emergency Department of a university-affiliated teaching hospital with suspected ACS. All patients underwent 12 h troponin T testing and were followed up by telephone and chart review. <\/p>\n\n\n\n

Outcomes:<\/strong> Death or AMI (excluding the index event) and the occurrence of major adverse cardiac events (MACEs) within 6 months.<\/p>\n\n\n\n

Results:<\/strong>Troponin T elevation below the functional sensitivity predicted the risk of death and AMI (adjusted OR 4.6, p.0.039) and MACE (adjusted OR 11.10, p<0.0001) independently of the Thrombolysis in Myocardial Infarction risk score and creatinine levels. Utilising the 99th percentile cut-off, an extra 17 MACEs could be predicted per 1000 patients treated at a cost of identifying 11 patients who would not have developed an event. <\/p>\n\n\n\n

Conclusions:<\/strong>The results suggest that adopting the lower troponin cut-off would reduce the proportion of \u2018false negatives\u2019 (patients with negative troponin who develop MACE) from 9.6% to 8.9%. Whether this reduction in \u2018false negatives\u2019 justifies the increase in \u2018false positives\u2019 warrants further investigation and discussion.<\/p>\n\n\nFull Text<\/span><\/a>","protected":false},"excerpt":{"rendered":"

Body, R., McDowell, G., Carley, S., Ferguson, J. & Mackway-Jones, K. (2010) \u2018Diagnosing acute myocardial infarction with troponins: how low can you go?\u2019 Emerg Med J. 27 pp. 292-296. Background:Recent consensus guidelines state that acute myocardial infarction (AMI) may be diagnosed in<\/p>\n","protected":false},"author":1,"featured_media":593,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"jetpack_post_was_ever_published":false,"_links_to":"","_links_to_target":""},"jetpack_shortlink":"https:\/\/wp.me\/P9tPlw-ay","jetpack-related-posts":[{"id":732,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=732","url_meta":{"origin":654,"position":0},"title":"Novel hs-cTn Assay with a Single Serum Test in ED.","date":"July 21, 2019","format":false,"excerpt":"3D illustration of Heart - Part of Human Organic. Objectives To evaluate diagnostic accuracy of a high-sensitivity cardiac troponin I (hs-cTnI) assay for acute coronary syndromes (ACS) in the Emergency Department (ED). The assay has high precision at low concentrations and can detect cTnI in 96.8% of healthy individuals.\u00a0 Methods\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/07\/Screenshot-2019-07-21-at-10.53.34-e1563702957497.png?fit=364%2C500&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":549,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=549","url_meta":{"origin":654,"position":1},"title":"PhD Project: BEST Study","date":"January 11, 2019","format":false,"excerpt":"Expediting the confirmation of acute myocardial infarction with point of care troponin and heart fatty acid binding protein testing to facilitate early intervention in emergency department Cardiac troponin is the reference standard biomarker for the diagnosis of acute myocardial infarction (AMI). In the appropriate clinical context, the detection of a\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":506,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=506","url_meta":{"origin":654,"position":2},"title":"Beside Evaluation of Troponin (BEST) Study","date":"January 1, 2019","format":false,"excerpt":"The BEST Study aims to determine whether troponin testing using \u00a0point of care can accurately diagnose acute myocardial infarction (AMI) in the Emergency Department. Approximately 3% of patients who attend an Emergency Department have chest pain that the clinician who treats them initially suspects may have been caused by an\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Cardiac-Marker-Test-Pages-1.png?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":650,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=650","url_meta":{"origin":654,"position":3},"title":"Modified TIMI Score","date":"February 7, 2019","format":false,"excerpt":"Body, R., Carley, S.,\u00a0McDowell, G.\u00a0& Mackway-Jones. K. (2009) \u2018Can a modified TIMI risk score help to guide patient disposition.\u2019\u00a0Emerg Med J26 pp. 95-99.\u00a0 Background: The thrombolysis in myocardial infarction (TIMI) risk score has been shown to risk stratify patients with suspected acute coronary syndromes (ACS) effectively in the emergency department\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Modified-TIMI-1-e1549807787719.png?fit=400%2C315&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":646,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=646","url_meta":{"origin":654,"position":4},"title":"Undetectable hs-cTnT","date":"February 7, 2019","format":false,"excerpt":"Body, R., Carley, S.,\u00a0McDowell, G., Jaffe, A.S., France, M., Cruickshank, K., Wibberley, C., Nuttall, M. & Mackway-Jones, K. (2011) \u2018Rapid exclusion of acute myocardial infarction in patients\u2019 with undetectable troponin using a high sensitivity assay.\u2019\u00a0J Am Coll Cardiol58 pp. 1332-1339. Objectives:This paper sought to evaluate whether high sensitivity troponin (hs-cTnT)\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/JACC-paper-e1549807840111.png?fit=400%2C268&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":641,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=641","url_meta":{"origin":654,"position":5},"title":"A FABP-ulous rule out strategy","date":"February 7, 2019","format":false,"excerpt":"Body, R.,\u00a0McDowell, G., Carley, S., Wibberley, C., Ferguson, J. & Mackway-Jones, K. (2011) \u2018A FABP-ulous rule out strategy? 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