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Clinical Relevance of the 99th Percentile Upper Reference Limit for High-Sensitivity Cardiac Troponin Assays

Clinical chemistry (Baltimore, Md.), 2020-03, Vol.66 (3), p.403-405 [Peer Reviewed Journal]

COPYRIGHT 2020 American Association for Clinical Chemistry, Inc. ;Copyright American Association for Clinical Chemistry Mar 2020 ;ISSN: 0009-9147 ;EISSN: 1530-8561 ;DOI: 10.1093/clinchem/hvz038 ;PMID: 32109295

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Title:
Clinical Relevance of the 99th Percentile Upper Reference Limit for High-Sensitivity Cardiac Troponin Assays
Author: Gore, M Odette ; de Lemos, James A
Subjects: Age ; Algorithms ; Artificial intelligence ; Assaying ; Biological Assay ; Biomarkers ; Calcium-binding protein ; Cardiovascular disease ; Clinical decision making ; Clinical medicine ; Decision making ; Emergency medical care ; Female ; Heart attacks ; Humans ; Learning algorithms ; Machine learning ; Male ; Medical colleges ; Medical research ; Medicine, Experimental ; Myocardial infarction ; Myocardial Infarction - diagnosis ; Regulatory approval ; Troponin ; Troponin I ; URLs
Is Part Of: Clinical chemistry (Baltimore, Md.), 2020-03, Vol.66 (3), p.403-405
Description: According to the 2018 Fourth Universal Definition of Myocardial Infarction (UDMI), acute myocardial injury is represented by an acute rise and/or fall in cTn values, with at least 1 cTn value above the assay's 99th percentile upper reference limit (URL) (3). [...]the 99th percentile URLs for cTn assays are, by convention, derived from normal reference populations (4), but there is no consensus regarding the most appropriate inclusion and exclusion criteria to define the normal reference population, nor is there consensus regarding statistical methodology. Preliminary evidence supports, for example, a machine learning approach using age, sex, and paired hs-cTn values as superior to a standard 0/3-hour hs-cTn protocol using the 99th percentile URL (12). [...]strategies are validated and operationalized, the most sensible solution to the conundrum surrounding the 99th percentile URL for hs-cTn assays may be to de-emphasize the importance of rigid hs-cTn cutoffs in clinical decision-making while placing more emphasis on appropriate strategies for MI ruleout and on serial cTn changes for acute MI diagnosis. [...]we believe that the implications of their study go even further, raising questions as to whether even a carefully determined 99th percentile URL can be considered reliable.
Publisher: England: American Association for Clinical Chemistry, Inc
Language: English
Identifier: ISSN: 0009-9147
EISSN: 1530-8561
DOI: 10.1093/clinchem/hvz038
PMID: 32109295
Source: MEDLINE
ProQuest Central

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Clinical Relevance of the 99th Percentile Upper Reference Limit for High-Sensitivity Cardiac Troponin Assays

COPYRIGHT 2020 American Association for Clinical Chemistry, Inc. ;Copyright American Association for Clinical Chemistry Mar 2020 ;ISSN: 0009-9147 ;EISSN: 1530-8561 ;DOI: 10.1093/clinchem/hvz038 ;PMID: 32109295

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