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Hello Tim As I am not a user of the Roche Troponin T method and thus do not have the package insert, how does your cutoff of 13 compare to the Roche AMI cutoff? The second question is related to cardiology query. Is the increase directly related to the cutoff of 13 or is it more related to the 100% increase. I suspect your algorithm is comparing 2 serial results. If it is based on the serial results, prior to instituting did you perform an ROC analysis? Reason I ask is that I have seen delta change algorithms without prior analysis confirming AMI based on a delta change cause issues. Literature now is clear that an increase in circulating troponin is consistent with myocardial cell insult yet not necessarily due to an AMI. Thoughts? Joe I From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Reynolds Tim Sent: Monday, November 01, 2010 10:31 AM To: [log in to unmask] Subject: Sensitive Troponin T tests We have just changed from Siemens TnI to Roche hS-TnT testing. Prior to the changes we consulted with several other labs and took their advice on what to use as cut offs. As a result we have the following as our standard report comment. Acute coronary syndrome is diagnosed by history,ECG changes,initial troponin T level and change after 6 hours.Cardiovascular risk is related to presence and level of troponin T. Troponin T>13 or 100% increase in troponin T concentration after 6 hours indicates myocardial damage. Two troponin T levels below 13ng/L, 6 hours apart,excludes myocardial infarction. I have just been asked by cardiology why there has been a massive increase in the number of patients with high / borderline Troponin results. I suggested that perhaps they should stop A&E ordering it on every patient who attends casualty with a pain higher than their big toe but seriously, the increase in sensitivity does seem to be causing big problems with admitting more patients. Could other users of high sensitivity TnT assays please tell me what they use as their significance thresholds. Thanks., TIM ************************************************************************ ************** Prof. Tim Reynolds Consultant Chemical Pathologist Burton Hospitals NHS Foundation Trust work tel: 01283 511511 ext 4035 work fax: 01283 593064 work email: [log in to unmask] home email: [log in to unmask] work URL: www.burtonhospitals.nhs.uk <file:///\\www.burtonhospitals.nhs.uk> This e-mail, and any files transmitted with it, are confidential and intended solely for the use of the individual to whom it is addressed. If you are not the intended recipient please destroy this message, delete any copies held on your systems, and notify the sender immediately. You should not retain copy or use this e-mail for any purpose, nor disclose all or any part of its content to any other person. If you have received this e-mail in error, please notify me on 01283 511511 Ext 4035 [Picture of tree not available] Please consider the environment before printing this e-mail This corporate email signature and disclaimer is now a Trust requirement. This has been enforced by Deborah Price, Acting Director of Corporate Development and Helen Ashley, Chief Executive. ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/