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
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01283 593064
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