Coronary disease & ACSSecondary analysis
High-Sensitivity Cardiac Troponin T-gen6 Assay in Suspected Myocardial Infarction
- Secondary analysis of the APACE prospective diagnostic study
- international
- central adjudication
- internal and external validation
Authors' conclusion
The novel hs-cTnT-gen6 assay demonstrated excellent and comparable diagnostic performance to the established hs-cTnT-gen5 assay with fewer patients identified as having myocardial injury. Use-optimized, assay-specific cutoffs for the European Society of Cardiology 0/1- and 0/2-hour algorithms provided very high sensitivity and high specificity.
Study context
- Population
- Patients presenting to the ED with suspected MIMI in 616 (18.4%)
- Participants
- 3,346 patients
- Comparison
- hs-cTnT-gen6 vs hs-cTnT-gen5 assay
- Primary endpoint
- Clinical (analytical and diagnostic) performance and use-optimized cutoffs for the ESC 0/1- and 0/2-hour algorithms
Primary result
As reported in the abstract
Diagnostic accuracy at ED presentation (AUC) and myocardial injury (concentration above upper reference limit) · ED presentation
| Group | AUC | Myocardial injury |
|---|---|---|
| hs-cTnT-gen6 | 0.927 (95% CI: 0.918-0.937) | 35.9% |
| hs-cTnT-gen5 | 0.931 (95% CI: 0.921-0.94) | 43.5% |
- hs-cTnT-gen6 vs hs-cTnT-gen5: P < 0.001 — myocardial injury 35.9% vs 43.5%
Further findings
Myocardial injury (concentration above upper reference limit)
P < 0.001
- ESC 0/1-hour algorithm with hs-cTnT-gen6 cutoffs (rule-out <8 ng/L if onset >3 h or <18 ng/L with delta <2 ng/L; rule-in ≥112 ng/L or delta ≥10 ng/L)
- 56.3% · Ruled out · Sensitivity 99.7% (95% CI: 98.3%-99.9%) · Ruled in 20.0% · Specificity 93.4% (95% CI: 92.0%-94.6%)
- ESC 0/2-hour algorithm with hs-cTnT-gen6 cutoffs (rule-out <8 ng/L if onset >3 h or <18 ng/L with delta <4 ng/L; rule-in ≥112 ng/L or delta ≥15 ng/L)
- 51.1% · Ruled out · Sensitivity 99.7% (95% CI: 98.1%-99.9%) · Ruled in 23.9% · Specificity 92.7% (95% CI: 90.8%-94.2%)
- ESC 0/2-hour algorithm with hs-cTnT-gen6 cutoffs (rule-out <8 ng/L if onset >3 h or <18 ng/L with delta <4 ng/L; rule-in ≥112 ng/L or delta ≥15 ng/L): Consistent in sensitivity analyses and external validation cohort
Single gen6 cutoff <6 ng/L at presentation, NSTEMI rule-out
- Ruled out, irrespective of chest pain onset
- 30.0%
- Sensitivity
- 100% (95% CI 99.4%-100%)
Original publication
High-Sensitivity Cardiac Troponin T-gen6 Assay in Suspected Myocardial Infarction. J Am Coll Cardiol. Published 25 March 2026. doi:10.1016/j.jacc.2025.12.052
Summarised from the published abstract; every number is checked against it