Observational studyBMJ (Clinical research ed.)2019
True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study.
Observational study in BMJ (Clinical research ed.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 25 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Is the Current Threshold for Diagnosis of "Abnormality", Including Non ST Elevation Myocardial Infarction, Using Raised Highly Sensitive Troponin Appropriate for a Hospital Population? The CHARIOT Study
Action of Glycation and Inflammation in Operative Ischemic Heart Disease
Who cites it
25 citing papers in PubMed, 53 citations in OpenAlex.
- Presentation cardiac troponin and early computed tomography coronary angiography in patients with suspected acute coronary syndrome: a pre-specified secondary analysis of the RAPID-CTCA trial.European heart journal. Acute cardiovascular care · 2022Trial
- Assessment of Oxygen Supply-Demand Imbalance and Outcomes Among Patients With Type 2 Myocardial Infarction: A Secondary Analysis of the High-STEACS Cluster Randomized Clinical Trial.JAMA network open · 2022Trial
- Cardiac-specific troponin-I (cTnI) in a post-mortem setting.International journal of legal medicine · 2025Article
- Impact of Elevated Troponin Level at the Time of Sepsis Recognition on the Clinical Outcomes: A Propensity Score-Matched Cohort Study.Journal of the American Heart Association · 2025Article
- Type 2 myocardial infarction: challenges in diagnosis and treatment.European heart journal · 2025Review
- Enhancing lateral flow immunoassay performance for cardiac troponin I detection with pore-size tailored silica nanoparticles and smartphone-based "AdaptiScan" analysis.Frontiers in bioengineering and biotechnology · 2025Article
- Relevance of surveillance manual for the early detection of immune checkpoint inhibitor-induced myocarditis: A case series.Asia-Pacific journal of oncology nursing · 2024Article
- Management of Acute Coronary Syndrome in Elderly Patients: A Narrative Review through Decisional Crossroads.Journal of clinical medicine · 2024Review
- Acute Myocardial Infarction in the Setting of Pulmonary Hypertension due to a Patent Foramen Ovale and Paradoxical Embolism.Case reports in pulmonology · 2024Article
- High-Sensitivity Troponin I and Cardiovascular Events in Stable Coronary Artery Disease: Insights from a Longitudinal Outpatient Study.International journal of molecular sciences · 2023Article
- Is high sensitivity troponin, taken regardless of a clinical indication, associated with 1 year mortality in critical care patients?Journal of the Intensive Care Society · 2023Article
- A pipeline to further enhance quality, integrity and reusability of the NCCID clinical data.Scientific data · 2023Article
- Myocardial injury defined as elevated high-sensitivity cardiac troponin T is associated with higher mortality in patients seeking care at emergency departments with acute dyspnea.BMC emergency medicine · 2023Article
- The Relationship Between Cardiac Troponin in People Hospitalised for Exacerbation of COPD and Major Adverse Cardiac Events (MACE) and COPD Readmissions.International journal of chronic obstructive pulmonary disease · 2023Article
- Influence of Age on the Diagnosis of Myocardial Infarction.Circulation · 2022Article
- A 15-year-old with chest pain: An unexpected etiology.SAGE open medical case reports · 2022Article
- Elderly patients with non-cardiac admissions and elevated high-sensitivity troponin: the prognostic value of renal function.World journal of cardiology · 2021Article
- Cardiac troponin and defining myocardial infarction.Cardiovascular research · 2021Review
- Distribution of contemporary sensitivity troponin in the emergency department and relationship to 30-day mortality: The CHARIOT-ED substudy.Clinical medicine (London, England) · 2020Article
- Rarely pure and never simple: interpreting investigation results in the clinical context.Clinical medicine (London, England) · 2020Article
Corrections and comments
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Authors and funding
17 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine the distribution, and specifically the true 99th centile, of high sensitivity cardiac troponin I (hs-cTnI) for a whole hospital population by applying the hs-cTnI assay currently used routinely at a large teaching hospital.
designProspective, observational cohort study.
settingUniversity Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom, between 29 June 2017 and 24 August 2017.
participants20 000 consecutive inpatients and outpatients undergoing blood tests for any clinical reason. Hs-cTnI concentrations were measured in all study participants and nested for analysis except when the supervising doctor had requested hs-cTnI for clinical reasons.
main outcome measuresDistribution of hs-cTnI concentrations of all study participants and specifically the 99th centile.
resultsThe 99th centile of hs-cTnI for the whole population was 296 ng/L compared with the manufacturer's quoted level of 40 ng/L (currently used clinically as the upper limit of normal; ULN). Hs-cTnI concentrations were greater than 40 ng/L in one in 20 (5.4%, n=1080) of the total population. After excluding participants diagnosed as having acute myocardial infarction (n=122) and those in whom hs-cTnI was requested for clinical reasons (n=1707), the 99th centile was 189 ng/L for the remainder (n=18 171). The 99th centile was 563 ng/L for inpatients (n=4759) and 65 ng/L for outpatients (n=9280). Patients from the emergency department (n=3706) had a 99th centile of 215 ng/L, with 6.07% (n=225) greater than the recommended ULN. 39.02% (n=48) of all patients from the critical care units (n=123) and 14.16% (n=67) of all medical inpatients had an hs-cTnI concentration greater than the recommended ULN.
conclusionsOf 20 000 consecutive patients undergoing a blood test for any clinical reason at our hospital, one in 20 had an hs-cTnI greater than the recommended ULN. These data highlight the need for clinical staff to interpret hs-cTnI concentrations carefully, particularly when applying the recommended ULN to diagnose acute myocardial infarction, in order to avoid misdiagnosis in the absence of an appropriate clinical presentation.
trial registrationClinicaltrials.gov NCT03047785.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.