Discordant Diagnoses of Acute Myocardial Infarction due to the Different Use of Assays and Cut-Off Points of Cardiac TroponinsLyck Hansen M.a · Saaby L.b · Nybo M.a · Rasmussen L.M.a · Thygesen K.c · Mickley H.b · Svenstrup Poulsen T.b
Departments of aClinical Biochemistry and Pharmacology and bCardiology, Odense University Hospital, Odense, and cDepartment of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Article / Publication Details
Objectives: Several assays for the measurement of cardiac troponin (cTn) are available, but differences in their analytical performances may affect the diagnosis of acute myocardial infarction (MI). Methods: A survey was conducted at all Danish departments of clinical biochemistry at hospitals receiving patients with suspected acute MI to gather information about the assay and cut-off value used. cTn was measured in blood samples from 574 patients enrolled into the Odense Chest Pain Biobank with 3 different assays: the 4th generation cTnT (cTnT4th), high-sensitivity cTnT (cTnThs; Roche Diagnostics) and cTnI (Abbott Diagnostics). To evaluate concordance, patients were dichotomised according to the 99th percentile value for each assay. Additionally, a cut-off at 50 ng/l for cTnThs was used, as this is the currently employed cut-off point in Denmark. Results: Using a cTnT4th cut-off value of >0.03 µg/l, 130 patients (23%) had potential MI. With the cTnThs assay and cut-off values at 50 versus 14 ng/l, respectively, 136 (24%) versus 301 (52%) patients had potential MI. With the cTnI cut-off point, 205 patients (36%) should be considered as having had an acute MI. Conclusions: The use of different cTn assays and cut-off values may result in a discordant frequency of MI diagnoses. This makes efforts to harmonize cTn assays and cut-off levels mandatory.
© 2012 S. Karger AG, Basel
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