Analytical Issues Surrounding Troponin Assays

Troponin Concentrations and Diagnostic Accuracy⁴

October 2010

Two recent papers in the New England Journal of Medicine reported results from large, multicenter evaluations of the diagnostic performance of several sensitive assays. The 2 studies were consistent in their conclusions, with an improved accuracy in AMI diagnosis. The cardiac troponin concentrations at patient presentation, as noted in this figure, were significantly higher in patients with a final diagnosis of AMI than in those who had a different diagnosis of unstable angina or other cardiac causes but not coronary artery disease. Diagnostic performance of the assays was similar in STEMI vs non-STEMI patients.

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Concentrations and Diagnostic Accuracy

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Jump to section:

• Introduction
• Challenges in Cardiovascular Medicine
• Shades of Gray
• Cardiac Markers
• Troponin Elevations are Greater and Persist Over Longer Time Periods
• 2007 Universal Definition of MI1
• Serial Sampling
• Elevation of cTn in Patients Without Overt Ischemic Heart Disease¹
• Analytic Confusion: Sensitivity and Imprecision of cTn Assays
• Analytical Definitions (Related to Troponin)
• Current Troponin Assays
• Defining the 99th Percentile (Normal Population)
• Troponin T or Troponin I: Does it Matter?
• Is CK-MB Needed Anymore?
• Recommendations for Point-of-Care Cardiac Marker Testing^2,3
• Does POCT Make Any Difference?
• What About the High-Sensitive Troponin Assays?
• Why All the Hype for High-Sensitivity Troponin?
• Troponin Concentrations and Diagnostic Accuracy⁴
• How Sensitive Does Troponin Testing Really Need to Be?
• Current Mayo Cardiac Biomarker Panel
• Current Mayo Cardiac Biomarker Panel
• Conclusions
• References
• Questions?
• Disclosure