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

 

 

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

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