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Time from symptom onset influences high-sensitivity troponin T diagnostic accuracy for the diagnosis of acute myocardial infarction

  • Li Guangquan , Huang Hualan , Nie Xin , He Yong , Song Haolan , Luo Tongxing , Gao Baoxiu , Nie Hu EMAIL logo and Li Guixing EMAIL logo
Published/Copyright: June 27, 2015
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 54 Issue 1

Abstract

Background: The time required for patients with acute chest pain to reach a hospital emergency department varies, possibly lowering the diagnostic performance of a general cut-off value for high-sensitivity cardiac troponin T (hs-cTnT) in diagnosing acute myocardial infarction (AMI). The aim of this study was to determine the cut-off values as calculated by receiver operating characteristic (ROC) of hs-cTnT at different times from onset of symptoms to admission, and to evaluate their diagnostic performance.

Methods: Our study included 3096 patients with symptoms suggestive of AMI. These patients were classified according to time from onset of symptoms to admission. The diagnostic accuracy was quantified by the area under the ROC curve (AUC).

Results: Of the patients, 1082 (49.3%) were diagnosed as having AMI (317 were non-ST segment elevation myocardial infarction [NSTEMI]). The AUC for hs-cTnT to diagnose AMI was 0.881 at <3 h after symptom onset, 0.940 at 3–6 h after symptom onset, 0.966 at 6–12 h after symptom onset, and 0.974 at >12 h after symptom onset. The threshold as determined by ROC of hs-cTnT was 13.5 ng/L to diagnose AMI at ≤3 h after symptom onset with a sensitivity of 81.8% and a specificity of 80.1%, 17.8 ng/L at 3–6 h after symptom onset with a sensitivity of 94.6% and a specificity of 84.3%, 30.0 ng/L at 6–12 h after symptom onset with a sensitivity of 95.9% and a specificity of 85.5%, and 58.0 ng/L at >12 h after symptom onset with a sensitivity of 92.7% and a specificity of 93.3%. The same observations were performed for the diagnosis of NSTEMI.

Conclusions: The ROC-determined cut-off value of hs-cTnT for AMI or NSTEMI diagnosis gradually increased with time from onset of symptoms to presentation. Using a higher cut-off value by ROC for hs-cTnT will improve its accuracy in diagnosing AMI or NSTEMI patients in late presenters. The higher value will enable physicians to more quickly rule in patients compared to the 99th percentile cut-off, and can rule out patients safely.

Keywords: acute myocardial infarction; diagnostic odds ratio; high-sensitivity cardiac troponin T; receiver operating characteristic curve; time from symptom onset
Corresponding authors: Nie Hu, Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, P.R. China, Phone/Fax: +86 028 85423709, E-mail: ; and Li Guixing, Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, P.R. China, Phone/Fax: +86 028 85422615, E-mail:
aLi Guangquan and Huang Hualan contributed equally to this work.

Acknowledgments

We are indebted to the patients who participated in this study, and to the ED staff as well as the laboratory technicians for their most valuable efforts. This study was supported by Roche Diagnostics GmbH in Shanghai (H1311115).

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2014-7-29
Accepted: 2015-6-1
Published Online: 2015-6-27
Published in Print: 2016-1-1

©2016 by De Gruyter

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https://doi.org/10.1515/cclm-2014-0776
Keywords for this article
acute myocardial infarction; diagnostic odds ratio; high-sensitivity cardiac troponin T; receiver operating characteristic curve; time from symptom onset

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Building a bridge to safe diagnosis in health care. The role of the clinical laboratory
  4. Capillary electrophoresis for the screening and diagnosis of inherited hemoglobin disorders. Ready for prime time?
  5. Reviews
  6. Hyperuricemia as risk factor for coronary heart disease incidence and mortality in the general population: a systematic review and meta-analysis
  7. Towards biomarker-based tests that can facilitate decisions about prevention and management of preeclampsia in low-resource settings
  8. Mini Review
  9. Clinical relevance of sST2 in cardiac diseases
  10. General Clinical Chemistry and Laboratory Medicine
  11. Preservation of urine free catecholamines and their free O-methylated metabolites with citric acid as an alternative to hydrochloric acid for LC-MS/MS-based analyses
  12. Performance characteristics of the VIDAS® 25-OH Vitamin D Total assay – comparison with four immunoassays and two liquid chromatography-tandem mass spectrometry methods in a multicentric study
  13. Differentiation of acute pyelonephritis from other febrile states in children using urinary neutrophil gelatinase-associated lipocalin (uNGAL)
  14. Early postoperative C-terminal agrin fragment (CAF) serum levels predict graft loss and proteinuria in renal transplant recipients
  15. Homocitrulline: a new marker for differentiating acute from chronic renal failure
  16. Hematology and Coagulation
  17. Development of hemoglobin typing control materials for laboratory investigation of thalassemia and hemoglobinopathies
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  19. Prevalence of hemostatic alterations in patients with recurrent spontaneous subconjunctival hemorrhage
  20. Reference Values and Biological Variations
  21. Reference intervals for 24 laboratory parameters determined in 24-hour urine collections
  22. First trimester PAPP-A2, PAPP-A and hCGβ in small-for-gestational-age pregnancies
  23. Cancer Diagnostics
  24. Clinical utility of one versus two faecal immunochemical test samples in the detection of advanced colorectal neoplasia in symptomatic patients
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  27. Prognostic significance of serum albumin level changes in acute ischemic stroke: the role of biological and analytical variation
  28. Correlates of serum hepcidin levels and its association with cardiovascular disease in an elderly general population
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