High-sensitivity cardiac troponin I in the general population – defining reference populations for the determination of the 99th percentile in the Gutenberg Health Study

Tanja Zeller; Francisco Ojeda; Fabian J. Brunner; Philipp Peitsmeyer; Thomas Münzel; Harald Binder; Norbert Pfeiffer; Matthias Michal; Philipp S. Wild; Stefan Blankenberg; Karl J. Lackner

doi:10.1515/cclm-2014-0619

Article

High-sensitivity cardiac troponin I in the general population – defining reference populations for the determination of the 99th percentile in the Gutenberg Health Study

Tanja Zeller , Francisco Ojeda , Fabian J. Brunner , Philipp Peitsmeyer , Thomas Münzel , Harald Binder , Norbert Pfeiffer , Matthias Michal , Philipp S. Wild , Stefan Blankenberg and Karl J. Lackner

Published/Copyright: October 6, 2014

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From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 53 Issue 5

Abstract

Background: The 99th percentile of cardiac troponin levels, determined in a reference population, is accepted as threshold for diagnosis of acute myocardial infarction (AMI). However, there is no common consensus of how to define the reference population. The aim of the present study was to determine 99th percentile reference values, determined by a high-sensitivity assay (hsTnI), according to different health status and cardiovascular risk factor prevalence in a large population-based sample.

Methods: Troponin I was determined using the Abbott ARCHITECT STAT highly sensitive troponin I immunoassay in 4138 participants of the Gutenberg Health Study.

Results: hsTnI was detectable in 81.6% of all individuals. The 99th percentile of the overall population was 27 ng/L. Age and gender had a prominent influence on these values. Exclusion of individuals with elevated natriuretic peptide levels or cardiac abnormalities resulted in lower 99th percentile values, whereas exclusion of individuals with an impaired estimated glomerular filtration rate (eGFR) or with prevalent coronary artery disease/myocardial infarction (CAD/MI) did not result in a meaningful change.

Conclusions: Troponin I, measured by a high-sensitivity assay, can be reliably detected in the vast majority of the general population. hsTnI values were dependent on age, gender as well as structural and functional cardiac abnormalities.

Keywords: high-sensitivity assay; 99th percentile; population-based; reference values; troponin I

Corresponding authors: Tanja Zeller, Clinic of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany, Phone: +49 40 741056575, E-mail: t.zeller@uke.de; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany; and Karl J. Lackner, Department of Laboratory Medicine, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany, Phone: +49 6131 177190, E-mail: karl.lackner@unimedizin-mainz.de

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

Financial support: Abbott Diagnostics provided test reagents for high-sensitive troponin I determinations within the frame of the Gutenberg Health Study. This work has been supported by the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement No. HEALTH-F2-2011-278913 (BiomarCaRE). Stefan Blankenberg has received honoraria from Abbott Diagnostics, Siemens, Brahms/Thermo Fisher, and Roche Diagnostics and is a consultant for Thermo Fisher.

Employment or leadership: None declared.

Honorarium: Karl J. Lackner has received honorari from Abbott Diagnostics, Siemens and bioMérieux.

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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The online version of this article (DOI: 10.1515/cclm-2014-0619) offers supplementary material, available to authorized users.

Received: 2014-6-12

Accepted: 2014-9-11

Published Online: 2014-10-6

Published in Print: 2015-4-1

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Keywords for this article

high-sensitivity assay; 99th percentile; population-based; reference values; troponin I

High-sensitivity cardiac troponin I in the general population – defining reference populations for the determination of the 99th percentile in the Gutenberg Health Study

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