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Is the 99th Percentile the Optimal Reference Limit to Diagnose Myocardial Infarction with High Sensitivity Cardiac Troponin Assays in Patients with Chronic Kidney Disease?
Circulation. 2015 May 6;
Authors: Chaitman BR
Abstract
The estimated annual incidence of myocardial infarction in the United States is ~525,000 new attacks/year and ~210,000 recurrent attacks(1). The large number of events results in many emergency room visits for diagnostic evaluation to determine presence or absence of acute coronary syndrome (ACS) and need for hospital admission. The Third Universal Definition of Myocardial Infarction requires abnormal cardiac biomarkers in the context of acute myocardial ischemia supported by clinical, ECG, or cardiac imaging findings(2). Cardiac troponin is recommended as the preferred biomarker to document myocardial necrosis. A rise or fall of c-Tn with at least one value > 99(th) percentile of a reference control population using an assay with total imprecision at the 99(th) percentile <10% is recommended to meet biomarker criteria for types 1, 2 and 4b/c myocardial infarction (MI). For procedure related types 4a and 5 MI events, multiples > 99(th) percentile are recommended.
PMID: 25948540 [PubMed - as supplied by publisher]