Diagnostic and prognostic value of the sex-specific 99th percentile of four high-sensitivity cardiac troponin assays in patients with suspected myocardial infarction
Authors' conclusion
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.
Study context
- Population
- Patients with suspected myocardial infarction (MI)368 with NSTEMI
- Participants
- 2,718 patients
- Comparison
- Sex-specific vs unisex 99th percentiles of four high-sensitivity cardiac troponin (hs-cTn) assays
- Outcome
- Diagnostic performance of unisex and sex-specific 99th percentiles for NSTEMI (ESC 0/3 h algorithm; 4th Universal Definition of MI)
Methodological detailshs-cTn measured at presentation and after 3 h
- hs-cTn measured at presentation and after 3 h
Performance
As reported in the abstract
NSTEMI diagnosis, unisex 99th percentile
| Test or model | PPV | NPV |
|---|---|---|
| Elecsys hs-cTnT | 75.9 | 99.7 |
| Architect | 71.4 | 98.0 |
| Atellica | 76.1 | 97.7 |
| Pathfast | 66.6 | 97.7 |
PPV
Elecsys hs-cTnT75.9
Architect71.4
Atellica76.1
Pathfast66.6
NPV
Elecsys hs-cTnT99.7
Architect98.0
Atellica97.7
Pathfast97.7
Further findings
Composite of MI, revascularization, cardiac rehospitalization and death (long-term)
- Concentrations above 99th percentile: independent predictors, HR range
- 1.2-1.5, P < 0.001
- Sex-specific 99th percentiles did not significantly affect prognostic value
Original publication
Diagnostic and prognostic value of the sex-specific 99th percentile of four high-sensitivity cardiac troponin assays in patients with suspected myocardial infarction. Eur Heart J Acute Cardiovasc Care. Published 27 October 2023. doi:10.
Summarised from the published abstract; every number is checked against it