Direct comparison of high-sensitivity-cardiac troponin I vs. T for the early diagnosis of acute myocardial infarction
Key result
hs-cTnI and hs-cTnT both demonstrate high diagnostic and prognostic accuracy for AMI with small differences.
- P=0.62
- n=2,226
Why the study?
Does high-sensitivity cardiac troponin I compared to high-sensitivity cardiac troponin T improve diagnostic accuracy for NSTEMI in patients presenting to the emergency department with acute chest pain?
Key Points
- To directly compare the diagnostic and prognostic accuracy of high-sensitivity cardiac troponin I (hs-cTnI) and troponin T (hs-cTnT) assays for the early identification of acute myocardial infarction.
- Prospective multicenter study of 2,226 consecutive emergency department patients presenting with acute chest pain, followed for a mean duration of 24 months.
- Blood concentrations of hs-cTnI (Abbott) and hs-cTnT (Roche) were measured at presentation, with final NSTEMI diagnoses adjudicated by two independent cardiologists.
- Overall diagnostic accuracy for NSTEMI across 2,226 patients (18% event rate) did not differ significantly between hs-cTnI (AUC: 0.93, 95% CI: 0.92–0.94) and hs-cTnT (AUC: 0.94, 95% CI: 0.92–0.94; P = 0.62).
- In early presenters (<3 h from chest pain onset), hs-cTnI demonstrated superior diagnostic accuracy (AUC: 0.92, 95% CI: 0.89–0.94 vs hs-cTnT AUC: 0.89, 95% CI: 0.86–0.91; P = 0.019), whereas hs-cTnT was superior in late presenters (AUC: 0.96, 95% CI: 0.94–0.96 vs hs-cTnI AUC: 0.94, 95% CI: 0.93–0.95; P = 0.007).
- Prognostic accuracy for 24-month all-cause mortality was significantly higher for hs-cTnT (AUC: 0.80, 95% CI: 0.78–0.82) compared with hs-cTnI (AUC: 0.75, 95% CI: 0.73–0.77; P < 0.001).
Study Design
Type
Observational (n=2,226)
Multicenter
Yes
Structured PICO
Does high-sensitivity cardiac troponin I compared to high-sensitivity cardiac troponin T improve diagnostic accuracy for NSTEMI in patients presenting to the emergency department with acute chest pain?
P
Population
2,226 consecutive patients presenting to the emergency department with acute chest pain, followed for a mean of 24 months.
E
Exposure
High-sensitivity cardiac troponin I (hs-cTnI Abbott)
C
Comparator
High-sensitivity cardiac troponin T (hs-cTnT Roche)
O
Outcome
Diagnostic accuracy for NSTEMI at presentation as quantified by the area under the receiver-operating-characteristics curve (AUC)surrogate
Main Result
Absolute Event Rate: 0.93% vs 0.94%
p-value: p=0.62
Both hs-cTnI and hs-cTnT offer high overall diagnostic accuracy for NSTEMI, with hs-cTnI performing slightly better in early presenters (<3 h) and hs-cTnT in late presenters and for long-term mortality prognosis.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“It is reassuring for clinicians to know that both hs-cTnT and hs-cTnI perform exceptionally well for the early diagnosis of myocardial infarction when applied within a triage algorithm, such as the European Society of Cardiology 0/1-hour algorithm. Both assays provide high safety for ruling out myocardial infarction and excellent accuracy for ruling it in.”
“This article doesn't show anything convincingly new between high-sensitivity troponin I and high-sensitivity troponin T.”
“The main message is that there are a lot of similarities in the performance of these two pathways. But to some extent, related to differences in how they were derived, it's clear that performance is also different, so that sites now have, for the first time, solid data to consider whether the benefit of option one or possibly the benefit of option two might be more attractive to them.”
Implication
Clinicians may use either hs-cTnI or hs-cTnT for AMI triage; leaves open which to prefer in early presenters or for mortality prediction.
Abstract
AIM: It is unknown whether cardiac troponin (cTn) I or cTnT is the preferred biomarker in the early diagnosis of acute myocardial infarction without ST segment elevation (NSTEMI). METHODS AND RESULTS: In a prospective multicentre study, we measured cTnI and cTnT using clinically available high-sensitivity assays (hs-cTnI Abbott and hs-cTnT Roche) and compared their diagnostic and prognostic accuracies in consecutive patients presenting to the emergency department with acute chest pain. The final diagnosis was adjudicated by two independent cardiologists using all information pertaining to the individual patient. The mean follow-up was 24 months. Among 2226 consecutive patients, 18% had an adjudicated final diagnosis of NSTEMI. Diagnostic accuracy at presentation as quantified by the area under the receiver-operating-characteristics curve (AUC) for NSTEMI was very high and similar for hs-cTnI [AUC: 0.93, 95% confidence interval (CI) 0.92-0.94] and hs-cTnT (0.94, 95% CI: 0.92-0.94) P = 0.62. In early presenters (<3 h since chest pain onset) hs-cTnI showed a higher diagnostic accuracy (AUC: 0.92, 95% CI: 0.89-0.94) when compared with hs-cTnT AUC (0.89, 95% CI: 0.86-0.91) (P = 0.019), while hs-cTnT was superior in late presenters [AUC hs-cTnT 0.96 (95% CI: 0.94-0.96) vs. hs-cTnI 0.94 (95% CI: 0.93-0.95); P = 0.007]. The prognostic accuracy for all-cause mortality, quantified by AUC, was significantly higher for hs-cTnT (AUC: 0.80; 95% CI: 0.78-0.82) when compared with hs-cTnI (AUC: 0.75; 95% CI: 0.73-0.77; P < 0.001). CONCLUSION: Both hs-cTnI and hs-cTnT provided high diagnostic and prognostic accuracy. The direct comparison revealed small but potentially important differences that might help to further improve the clinical use of hs-cTn.
Discussion
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Cite This Study
Giménez et al. (2014) conducted an observational in Acute chest pain / suspected NSTEMI (n=2,226). High-sensitivity cardiac troponin I (hs-cTnI) vs. High-sensitivity cardiac troponin T (hs-cTnT) was evaluated on Diagnostic accuracy for NSTEMI at presentation (AUC) (p=0.62). High-sensitivity cardiac troponin I and T showed similar diagnostic accuracy for NSTEMI at presentation (AUC 0.93 vs 0.94; P=0.62), though hs-cTnT had higher prognostic accuracy for mortality.