uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Decision limits and the reporting of cardiac troponin: Meeting the needs of both the cardiologist and the ED physician
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
Show others and affiliations
2015 (English)In: Critical reviews in clinical laboratory sciences, ISSN 1040-8363, Vol. 52, no 1, 28-44 p.Article, review/survey (Refereed) Published
Abstract [en]

Cardiac troponin is the preferred biomarker for defining the acute coronary syndrome and acute myocardial infarction. Currently, the only decision limit formally endorsed with regard to the cardiac troponins is the 99th percentile. This is a "rule-in" criterion, intended to ensure that only persons with the acute coronary syndrome are reviewed. The 99th percentile is an arbitrary cut point and there are many problems associated with its application, including defining a truly healthy population, the difficulty of standardisation of cardiac troponin assays, especially but not only cardiac troponin I, and the effects of age and sex on this parameter. The Emergency Department (ED) screens many more persons for possible acute coronary syndromes than actually have the condition and their needs are best met by a "rule-out" test that enables them to clear their busy departments of the many persons who do not actually have the condition. The needs of the ED are not optimally met using the 99th percentile. The index of individuality for the cardiac troponins is small and significant changes consistent with an acute coronary syndrome can occur without the 99th percentile being exceeded. It appears that the ED may be better served by use of delta troponin changes rather than the 99th percentile, but there are problems with this approach, particularly in persons who present late when troponin release has plateaued. In addition, there are many non-acute coronary syndrome causes for cardiac troponin release. The needs of the cardiologist and the ED physician are so different that it may be inappropriate for both groups to use the same diagnostic criteria for cardiac troponin, and it is of great importance that cardiac troponin measurement be used as only one part of the assessment of the person presenting with possible acute coronary syndrome.

Place, publisher, year, edition, pages
2015. Vol. 52, no 1, 28-44 p.
National Category
Cardiac and Cardiovascular Systems
URN: urn:nbn:se:uu:diva-241186DOI: 10.3109/10408363.2014.972497ISI: 000348121800003PubMedID: 25397345OAI: oai:DiVA.org:uu-241186DiVA: diva2:777765
Available from: 2015-01-08 Created: 2015-01-08 Last updated: 2015-03-11Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Lindahl, Bertil
By organisation
UCR-Uppsala Clinical Research Center
In the same journal
Critical reviews in clinical laboratory sciences
Cardiac and Cardiovascular Systems

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 189 hits
ReferencesLink to record
Permanent link

Direct link