High-Sensitivity Cardiac Troponin Assays—Change Is Important

[摘要] To the Editor:The recent publication by Aldous and colleagues in Clinical Chemistry (1) starts an important discussion concerning the optimal change criteria that should be used with high-sensitivity (hs)1 cardiac troponin assays. This report suggests that an optimal relative change (i.e., percent δ) in hs cardiac troponin T (hs-cTnT) for predicting a major adverse cardiovascular event over a 1-year period is 3%. This relative difference was not significant, however, with respect to risk stratification (hazard ratio, 1.6; P = 0.052) and would not be considered an analytically robust change, because 3% is within the imprecision of the assay at concentrations measured with the low- and high-quality control materials provided by Roche Diagnostics for this assay. From the data presented, it appears that the percent δ values for hs-cTnT concentrations over 2 h were not important for long-term risk stratification; however, relative changes (e.g., 10% as determined by ROC curve analysis) did improve the detection of the index diagnosis of myocardial infarction (MI) in patients presenting …

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