ArticleAmerican heart journal2017
Use of troponin assay 99th percentile as the decision level for myocardial infarction diagnosis.
Article in American heart journal, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Myocardial Infarction in the ISCHEMIA Trial: Impact of Different Definitions on Incidence, Prognosis, and Treatment Comparisons.Circulation · 2021Trial
- High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial.Lancet (London, England) · 2018Trial
- PAPP-A Protein Diagnostic and Prognostic Significance in Acute Coronary Syndromes Without Persistent ST-T-Segment Elevation.Journal of clinical medicine · 2026Article
- 99th-Percentile Upper Reference Limit for the New Snibe High-Sensitivity Troponin I Assay in a Southeast Asian Population.Diagnostics (Basel, Switzerland) · 2025Article
- Interpretating Normal Values and Reference Ranges for Laboratory Tests.Journal of the American Board of Family Medicine : JABFM · 2025Review
- Article
- Cardiovascular Biomarkers: Lessons of the Past and Prospects for the Future.International journal of molecular sciences · 2022Review
- Universal Definition of Myocardial Infarction 99th Percentile versus Diagnostic Cut-off Value of Troponin I for Acute Coronary Syndromes.Arquivos brasileiros de cardiologia · 2022Article
- Subclinical myocardial dysfunction in patients recovered from COVID-19.Echocardiography (Mount Kisco, N.Y.) · 2021Observational
- Prognostic Value of Cardiac Troponin and Risk Assessment in Pediatric Supraventricular Tachycardia.Journal of clinical medicine · 2021Article
- High sensitivity Troponin-T for prediction of adverse events in patients with COVID-19.Biomarkers : biochemical indicators of exposure, response, and susceptibility to chemicals · 2020Observational
- Article
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30 authors.
Funding
Abstract
backgroundThe Universal Definition of Myocardial Infarction recommends the 99th percentile concentration of cardiac troponin in a normal reference population as part of the decision threshold to diagnose type 1 spontaneous myocardial infarction. Adoption of this recommendation in contemporary worldwide practice is not well known.
methodsWe performed a cohort study of 276 hospital laboratories in 31 countries participating in the National Heart, Lung, and Blood Institute-sponsored International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial. Each hospital laboratory's troponin assay manufacturer and model, the recommended assay's 99th percentile upper reference limit (URL) from the manufacturer's package insert, and the troponin concentration used locally as the decision level to diagnose myocardial infarction were ascertained.
resultsTwenty-one unique troponin assays from 9 manufacturers were used by the surveyed hospital laboratories. The ratio of the troponin concentration used locally to diagnose myocardial infarction to the assay manufacturer-determined 99th percentile URL was <1 at 19 (6.6%) laboratories, equal to 1 at 91 (31.6%) laboratories, >1 to ≤5 at 101 (35.1%) laboratories, >5 to ≤10 at 34 (11.8%) laboratories, and >10 at 43 (14.9%) laboratories. The variability in troponin decision level for myocardial infarction relative to the assay 99th percentile URL was present for laboratories in and outside of the United States, as well as for high- and standard-sensitivity assays.
conclusionsThere is substantial hospital-level variation in the troponin threshold used to diagnose myocardial infarction; only one-third of hospital laboratories currently follow the Universal Definition of Myocardial Infarction consensus recommendation for use of troponin concentration at the 99th percentile of a normal reference population as the decision level to diagnose myocardial infarction. This variability across laboratories has important implications for both the diagnosis of myocardial infarction in clinical practice as well as adjudication of myocardial infarction in clinical trials.
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