Abstract
Cardiac troponins are crucial for the diagnosis of acute myocardial infarction. Despite known differences in their diagnostic implication, there are no recommendations for only one of the two troponins, cardiac troponin I (cTnI) and troponin T (cTnT) so far. In an everyday routine diagnostic, cTnT (Roche) as well as cTnI (Abbott) were measured in 5667 samples from 3264 patient cases. We investigated the number of identical or discrepant troponin findings. Regarding cTnI, we considered both, sex-dependent and unisex cutoffs. In particular, the number of cTnT positive and cTnI negative results was strikingly high in 14.0% of cTnT positive samples and increases to 23.8% by using sex-specific cTnI cutoffs. This group was considerably greater than the group of cTnI positive and cTnT negative results, also after elimination of patients with an eGFR < 60 mL/min/1.73 m2. Comparing the troponin cases with a dynamic increase or decrease between two measurements, we saw a balanced number of discrepant cases (between cTnT+/cTnI− and cTnT−/cTnI+), which was, however, still present. Using ROC analysis, sex-dependent cutoffs improved sensitivity and specificity of cTnI. This study shows in a large cohort that comparing the two cardiac troponins does not amount to identical analytical results. Consideration of sex-dependent cutoffs may improve sensitivity and specificity.
Highlights
Acute myocardial infarction (AMI) is a life-threatening disorder that requires quick and safe diagnosis and therapy
A patient case was defined as positive according to cardiac troponin I (cTnI) or cTnT or both if there were at least two measurements within 12 h, one concentration was above the chosen threshold and one of the measurements showed a difference of at least 20% compared to the first measurement
A total of 5667 blood samples were measured for both cTnT and cTnI in the period from 27 September 2013 to 11 February 2014 (Table 1)
Summary
Acute myocardial infarction (AMI) is a life-threatening disorder that requires quick and safe diagnosis and therapy. Manufacturers have given gender-specific URLs for cTnI [15] only, but not for cTnT In this retrospective study on prospectively collected data, we wanted to work out differences between cTnI and cTnT results and with respect to the final diagnosis AMI. For this purpose, concentrations of both cTnT (Roche) and cTnI (Abbott) were measured in all patient blood samples with cTn concentration request. Results of the 5667 blood samples from 3264 patient cases were analyzed for the following aspects: (I) How many discrepant positive or negative cTnT and cTnI results are found when using alternatively genderindependent or gender-specific upper limits of the cTnI reference range? Results of the 5667 blood samples from 3264 patient cases were analyzed for the following aspects: (I) How many discrepant positive or negative cTnT and cTnI results are found when using alternatively genderindependent or gender-specific upper limits of the cTnI reference range? How are the rate of the discordances between cTnT and cTnI changes through elimination of patients with an eGFR < 60 mL/min/1.73 m2? (II) How many discrepant findings exist when comparing serial troponin measurements under consideration of marker kinetics and clinical diagnosis? (III) How does gender-specific cutoffs and kidney function influence specificity and sensitivity of the two cTn?
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