Diagnostic value of high sensitive troponin T in chest pain patients with no persistent ST-elevations

Abstract

Objectives. The aim of this study was to compare the early diagnostic value of the Roche high-sensitive troponin T (Hs-TnT) and that of conventional troponins. Design. A total of 233 consecutive chest pain patients without ST-elevations were included. Hs-TnT was compared with two conventional assays (Roche troponin T [fourth generation] and Beckman Coulter Accu-TnI) on admission and at two hours. Results. When acute Myocardial Infarction (MI) was defined by conventional troponins and prespecified decision limits (Hs-TnT ≥ 14 ng/l, conventional TnT ≥ 0.04 μg/l, and Accu-TnI ≥ 0.06 μg/l) were used, Hs-TnT had a higher sensitivity but a lower specificity than conventional troponins both on admission and after two hours. When the biomarkers were compared in a ROC analysis there were no significant differences with regard to AUC. When acute MI was defined by Hs-TnT, the diagnostic performance of Hs-TnT remained very high (on admission: sensitivity 96%, specificity 85%, at two hours: sensitivity 99%, specificity 83%) whereas that of conventional troponins became lower, mainly because of lower sensitivity. Conclusion. In conclusion, when acute MI is defined by a high sensitive troponin assay, the use of Hs-TnT improves the early diagnostic accuracy compared with conventional troponins. By measuring Hs-TnT it seems possible to exclude acute MI already within the first few hours from admission.

Key words::

• Troponin
• chest pain
• myocardial infarction
• diagnosis

Acknowledgments

We are indebted to the staff at the CCU at Karolinska University Hospital, Huddinge and Margareta Berglund (RN) for all assistance. Financial support was provided through a regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institute. This study was also supported by grants from the Swedish Heart and Lung Foundation, the National Board of Health and Welfare and Roche Diagnostics Scandinavia AB who also provided Hs-TnT and TnT test kits. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

NOTICE OF CORRECTION

[ePub ahead of print] 24 March 2011, DOI: 10.3109/14017431.2011.565792. The Early Online version of this article published ahead of print on 24 March 2011 contained an error in the abstract and on page 2 where the unit for TnT and TnI were shown as g/L instead of as μg/L. This has now been corrected.