Home Evaluation of four sensitive troponin assays for risk assessment in acute coronary syndromes using a new clinically oriented approach for comparison of assays
Article
Licensed
Unlicensed Requires Authentication

Evaluation of four sensitive troponin assays for risk assessment in acute coronary syndromes using a new clinically oriented approach for comparison of assays

  • Bertil Lindahl EMAIL logo , Kai M. Eggers , Per Venge and Stefan James
Published/Copyright: April 6, 2013
Become an author with De Gruyter Brill
Submit Manuscript Author Information
Clinical Chemistry and Laboratory Medicine
From the journal Clinical Chemistry and Laboratory Medicine Volume 51 Issue 9

Abstract

Background: Measurement of cardiac troponin T or I (cTnT; cTnI) is useful for risk prediction in acute coronary syndromes. The objective of the present study was to compare the prognostic capacity of four sensitive cardiac troponin assays using a new method for comparison.

Methods: Cardiac troponin was analyzed in serum samples from 1335 patients with acute coronary syndrome using the Elecsys high sensitivity TnT (hs-cTnT), ARCHITECT STAT high sensitivity TnI (hs-cTnI), Access AccuTnI (Acc-cTnI) and Architect cTnI (Arc-cTnI) assays. All patients were followed for 30 days regarding death and acute myocardial infarction (AMI), and for 1 year regarding mortality.

Results: By receiver operating characteristic (ROC) curve analyses, there were only minor differences in the area under the curves (AUC) between the assays. At a given sensitivity of 85% the hs-cTnT, Arc-cTnI and Acc-cTnI assays showed comparable specificities, while 90% or higher sensitivity was only possible to achieve with the hs-cTnT, hs-cTnI and Acc-cTnI assays. The highest odds ratios for death/AMI at 30 days and death at 1 year, respectively, were reached by cut-off levels yielding 95% sensitivity; these cut-off levels were below the respective 99th percentile levels.

Conclusions: By the adoption of a new method for the comparison of cardiac troponin assays we showed that the hs-cTnT, hs-cTnI and Acc-cTnI assays had comparable prognostic properties, while the Arc-cTnI assay had inferior prognostic sensitivity.

Keywords: acute coronary syndromes; prognosis; troponin
Corresponding author: Bertil Lindahl, Uppsala Clinical Research Center, University Hospital, 751 85 Uppsala, Sweden, Phone: +46 186119505, Fax: +46 18515570

References

1. Olatidoye AG, Wu AH, Feng YJ, Waters D. Prognostic role of troponin T versus troponin I in unstable angina pectoris for cardiac events with meta-analysis comparing published studies. Am J Cardiol 1998;81:1405–10.10.1016/S0002-9149(98)00200-8Search in Google Scholar

2. Lindahl B, Toss H, Siegbahn A, Venge P, Wallentin L. Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease. N Engl J Med 2000;343:1139–47.10.1056/NEJM200010193431602Search in Google Scholar

3. James S, Flodin M, Johnston N, Lindahl B, Venge P. The antibody configurations of cardiac troponin I assays may determine their clinical performance. Clin Chem 2006;52:832–7.10.1373/clinchem.2005.064857Search in Google Scholar

4. Saenger AK, Beyrau R, Braun S, Cooray R, Dolci A, Freidank H, et al. Multicenter analytical evaluation of a high-sensitivity troponin T assay. Clin Chim Acta 2010;412:748–54.10.1016/j.cca.2010.12.034Search in Google Scholar

5. Koerbin G, Tate J, Potter J, Cavanaugh J, Glasgow N, Hickman P. Characterisation of a highly sensitive troponin I assay and its application to a cardio-healthy population. Clin Chem Lab Med 2012;50:871–8.10.1515/cclm-2011-0540Search in Google Scholar

6. Vickers AJ, Lilja H. Cutpoints in clinical chemistry: time for fundamental reassessment. Clin Chem 2009;55:15–7.10.1373/clinchem.2008.114694Search in Google Scholar

7. Eggers KM, Jaffe AS, Lind L, Venge P, Lindahl B. Value of cardiac troponin I cutoff concentrations below the 99th percentile for clinical decision-making. Clin Chem 2009;55:85–92.10.1373/clinchem.2007.101683Search in Google Scholar

8. Lindahl B, Venge P, James S. The new high-sensitivity cardiac troponin T assay improves risk assessment in acute coronary syndromes. Am Heart J 2010;160:224–9.10.1016/j.ahj.2010.05.023Search in Google Scholar

9. Omland T, de Lemos JA, Sabatine MS, Christophi CA, Rice MM, Jablonski KA, et al. A sensitive cardiac troponin T assay in stable coronary artery disease. N Engl J Med 2009;361:2538–47.10.1056/NEJMoa0805299Search in Google Scholar

10. Lindahl B, Diderholm E, Lagerqvist B, Venge P, Wallentin L. Mechanisms behind the prognostic value of troponin T in unstable coronary artery disease: a FRISC II substudy. J Am Coll Cardiol 2001;38:979–86.10.1016/S0735-1097(01)01501-7Search in Google Scholar

11. Simoons ML. Effect of glycoprotein IIb/IIIa receptor blocker abciximab on outcome in patients with acute coronary syndromes without early coronary revascularisation: the GUSTO IV-ACS randomised trial. Lancet 2001;357:1915–24.10.1016/S0140-6736(00)05060-1Search in Google Scholar

12. Apple FS, Jaffe AS. Clinical implications of a recent adjustment to the high-sensitivity cardiac troponin T assay: user beware. Clin Chem 2012;58:1599–600.10.1373/clinchem.2012.194985Search in Google Scholar PubMed

13. Apple FS, Ler R, Murakami MM. Determination of 19 cardiac troponin I and T assay 99th percentile values from a common presumably healthy population. Clin Chem 2012;58:1574–81.10.1373/clinchem.2012.192716Search in Google Scholar PubMed

14. Venge P, James S, Jansson L, Lindahl B. Clinical performance of two highly sensitive cardiac troponin I assays. Clin Chem 2009;55:109–16.10.1373/clinchem.2008.106500Search in Google Scholar PubMed

15. Reichlin T, Hochholzer W, Bassetti S, Steuer S, Stelzig C, Hartwiger S, et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 2009;361:858–67.10.1056/NEJMoa0900428Search in Google Scholar PubMed

16. Eggers KM, Lagerqvist B, Venge P, Wallentin L, Lindahl B. Persistent cardiac troponin I elevation in stabilized patients after an episode of acute coronary syndrome predicts long-term mortality. Circulation 2007;116:1907–14.10.1161/CIRCULATIONAHA.107.708529Search in Google Scholar PubMed

17. Cook NR. Use and misuse of the receiver operating characteristic curve in risk prediction. Circulation 2007;115:928–35.10.1161/CIRCULATIONAHA.106.672402Search in Google Scholar PubMed

18. Agarwal SK, Avery CL, Ballantyne CM, Catellier D, Nambi V, Saunders J, et al. Sources of variability in measurements of cardiac troponin T in a community-based sample: the atherosclerosis risk in communities study. Clin Chem 2011;57:891–7.10.1373/clinchem.2010.159350Search in Google Scholar PubMed PubMed Central

19. Gillis JM, Dunselman P, Jarausch J, de Jong N, Cobbaert CM. Preanalytical storage does not affect 99th percentile cardiac troponin T concentrations measured with a high-sensitivity assay. Clin Chem 2013;59:442–3.10.1373/clinchem.2012.192211Search in Google Scholar PubMed

Received: 2013-1-7
Accepted: 2013-3-15
Published Online: 2013-04-06
Published in Print: 2013-09-01

©2013 by Walter de Gruyter Berlin Boston

Articles in the same Issue

  1. Masthead
  2. Masthead
  3. Editorials
  4. What is a biomarker? It’s time for a renewed definition
  5. Biomarker research and leading causes of death worldwide: a rather feeble relationship
  6. Thiosulfate in urine: new hope or new failure of a biomarker for prostate cancer?
  7. Review
  8. Acute coronary syndrome – the present and future role of biomarkers1)
  9. Mini Review
  10. Advance in molecular diagnostic tools for hepatitis B virus detection
  11. Opinion Paper
  12. Standardization and analytical goals for glycated hemoglobin measurement
  13. Guidelines and Recommendations
  14. Proposal for the use in emergency departments of cardiac troponins measured with the latest generation methods in patients with suspected acute coronary syndrome without persistent ST-segment elevation
  15. General Clinical Chemistry and Laboratory Medicine
  16. Current status of verification practices in clinical biochemistry in Spain
  17. Two site evaluation of the performance of a new generation point-of-care glucose meter for use in a neonatal intensive care unit
  18. Trp64Arg (rs4994) polymorphism of β3-adrenergic receptor gene is associated with hyperuricemia in a Chinese male population
  19. Quantification of vancomycin in human serum by LC-MS/MS
  20. Automated indirect immunofluorescence antinuclear antibody analysis is a standardized alternative for visual microscope interpretation
  21. Autocorrelation and cross-correlation between hCGβ and PAPP-A in repeated sampling during first trimester of pregnancy
  22. Platelet oxidative stress and systemic inflammation in chronic spontaneous urticaria
  23. Reference Values
  24. Establishment of reference values for novel urinary biomarkers for renal damage in the healthy population: are age and gender an issue?
  25. Risks of mortality associated with common laboratory tests: a novel, simple and meaningful way to set decision limits from data available in the Electronic Medical Record
  26. Cancer Diagnostics
  27. Cancer antigen 125, human epididymis 4, kallikrein 6, osteopontin and soluble mesothelin-related peptide immunocomplexed with immunoglobulin M in epithelial ovarian cancer diagnosis
  28. Thiosulfate in urine as a facilitator in the diagnosis of prostate cancer for patients with prostate-specific antigen less or equal 10 ng/mL
  29. Anemia and iron biomarkers in patients with early breast cancer. Diagnostic value of hepcidin and soluble transferrin receptor quantification1)
  30. Sensitive detection of EML4-ALK fusion oncoprotein of lung cancer by in situ proximity ligation assay
  31. Re-evaluation of laboratory predictors of response to current anemia treatment regimens of erythropoiesis stimulating agents in cancer patients
  32. Cardiovascular Diseases
  33. Evaluation of four sensitive troponin assays for risk assessment in acute coronary syndromes using a new clinically oriented approach for comparison of assays
  34. A combined index of cardiac biomarkers as a risk factor for early cardiovascular mortality in hemodialysis patients
  35. Prognostic utility of biochemical markers of cardiovascular risk: impact of biological variability
  36. Letters to the Editors
  37. Exploring the relationship between serum biomarkers, acute intracerebral changes and outcome after severe traumatic brain injury (TBI)
  38. Laboratory false-positive results: a clinician responsibility or a shared responsibility with requesting clinicians?
  39. The one hour lactose tolerance test
  40. High concentration of IgM-κ paraprotein causes over-estimation of serum total protein by certain biuret method
  41. Determining calculated free testosterone reference intervals in a normal adult male population
  42. Alveolar neopterin, procalcitonin, and IL-6 in relation to serum levels and severity of lung injury in ARDS
  43. Falsely elevated cobalamin concentration in multiple assays in a patient with pernicious anemia: a case study
  44. Leading Figures in Laboratory Medicine
  45. Research forever – Klaus Jung
https://doi.org/10.1515/cclm-2013-0023
Keywords for this article
acute coronary syndromes; prognosis; troponin

Articles in the same Issue

  1. Masthead
  2. Masthead
  3. Editorials
  4. What is a biomarker? It’s time for a renewed definition
  5. Biomarker research and leading causes of death worldwide: a rather feeble relationship
  6. Thiosulfate in urine: new hope or new failure of a biomarker for prostate cancer?
  7. Review
  8. Acute coronary syndrome – the present and future role of biomarkers1)
  9. Mini Review
  10. Advance in molecular diagnostic tools for hepatitis B virus detection
  11. Opinion Paper
  12. Standardization and analytical goals for glycated hemoglobin measurement
  13. Guidelines and Recommendations
  14. Proposal for the use in emergency departments of cardiac troponins measured with the latest generation methods in patients with suspected acute coronary syndrome without persistent ST-segment elevation
  15. General Clinical Chemistry and Laboratory Medicine
  16. Current status of verification practices in clinical biochemistry in Spain
  17. Two site evaluation of the performance of a new generation point-of-care glucose meter for use in a neonatal intensive care unit
  18. Trp64Arg (rs4994) polymorphism of β3-adrenergic receptor gene is associated with hyperuricemia in a Chinese male population
  19. Quantification of vancomycin in human serum by LC-MS/MS
  20. Automated indirect immunofluorescence antinuclear antibody analysis is a standardized alternative for visual microscope interpretation
  21. Autocorrelation and cross-correlation between hCGβ and PAPP-A in repeated sampling during first trimester of pregnancy
  22. Platelet oxidative stress and systemic inflammation in chronic spontaneous urticaria
  23. Reference Values
  24. Establishment of reference values for novel urinary biomarkers for renal damage in the healthy population: are age and gender an issue?
  25. Risks of mortality associated with common laboratory tests: a novel, simple and meaningful way to set decision limits from data available in the Electronic Medical Record
  26. Cancer Diagnostics
  27. Cancer antigen 125, human epididymis 4, kallikrein 6, osteopontin and soluble mesothelin-related peptide immunocomplexed with immunoglobulin M in epithelial ovarian cancer diagnosis
  28. Thiosulfate in urine as a facilitator in the diagnosis of prostate cancer for patients with prostate-specific antigen less or equal 10 ng/mL
  29. Anemia and iron biomarkers in patients with early breast cancer. Diagnostic value of hepcidin and soluble transferrin receptor quantification1)
  30. Sensitive detection of EML4-ALK fusion oncoprotein of lung cancer by in situ proximity ligation assay
  31. Re-evaluation of laboratory predictors of response to current anemia treatment regimens of erythropoiesis stimulating agents in cancer patients
  32. Cardiovascular Diseases
  33. Evaluation of four sensitive troponin assays for risk assessment in acute coronary syndromes using a new clinically oriented approach for comparison of assays
  34. A combined index of cardiac biomarkers as a risk factor for early cardiovascular mortality in hemodialysis patients
  35. Prognostic utility of biochemical markers of cardiovascular risk: impact of biological variability
  36. Letters to the Editors
  37. Exploring the relationship between serum biomarkers, acute intracerebral changes and outcome after severe traumatic brain injury (TBI)
  38. Laboratory false-positive results: a clinician responsibility or a shared responsibility with requesting clinicians?
  39. The one hour lactose tolerance test
  40. High concentration of IgM-κ paraprotein causes over-estimation of serum total protein by certain biuret method
  41. Determining calculated free testosterone reference intervals in a normal adult male population
  42. Alveolar neopterin, procalcitonin, and IL-6 in relation to serum levels and severity of lung injury in ARDS
  43. Falsely elevated cobalamin concentration in multiple assays in a patient with pernicious anemia: a case study
  44. Leading Figures in Laboratory Medicine
  45. Research forever – Klaus Jung
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 16.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/cclm-2013-0023/html
Scroll to top button