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David Plaut: Off the Cuff

Sensitivity of Troponin Assays

Published April 17, 2014 1:50 PM by David Plaut

One of my concerns regarding the increased sensitivity of the available troponin  assays (both T and I) is the number of patients with measureable cTn with the newer methods. To a great extent, this concern has been alleviated by a recent study of several commercial assays in a 90 minute window. Of 465 ER patients, there were 12 AMIs. At presentation, the clinical sensitivity and specificity were 83% and 82% for hs-cTnI. The sensitivity and specificity were 100% and 82% for hs-cTnI at 90 min. A change of a 30% increase from baseline to 90 min improved the specificity to 94% without lowering the sensitivity. When AMI was defined as a 30% change of hs-cTnI at t=0 and 90 min and one hs-cTnI result >99th percentile cutoff, more than 3 times as many patients met the diagnostic criteria for AMI compared to results from the normal sensitive troponin assay; 28 hs-cTnI vs. 9 with cTnI. This data coincides with the concept that an AMI can be ruled in (or out) in a considerably shorter time than what many hospitals use today. While this may put a burden on the laboratory, it is a better protocol than a 6 hour version. And if the protocol uses no more than 2 samples in most of the cases (as this data argues), the laboratory and phlebotomists will have fewer samples to process.

posted by David Plaut

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