Why the study?
Cardiac troponin concentrations are strongly influenced by age, prompting an evaluation of its diagnostic performance in older patients presenting with suspected myocardial infarction.
Does the use of age-adjusted 99th centile thresholds improve the diagnostic accuracy of high-sensitivity cardiac troponin I for myocardial infarction in older patients compared to guideline-recommended thresholds?
Population
46 435 consecutive patients aged 18 to 108 years presenting with suspected myocardial infarction
Comparison
Guideline-recommended sex-specific vs age-adjusted 99th centile thresholds across 3 age groups
Design
Secondary analysis of a multicenter trial
Authors
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Caution against routine use in patients ≥75 years due to lower sensitivity; leaves open optimal thresholds balancing accuracy in prospective studies.
Does the use of age-adjusted 99th centile thresholds improve the diagnostic accuracy of high-sensitivity cardiac troponin I for myocardial infarction in older patients compared to guideline-recommended thresholds?
Age significantly reduces the specificity and positive predictive value of cardiac troponin for diagnosing myocardial infarction, and age-adjusted thresholds fail to resolve this without severely compromising sensitivity.
Lowry et al. (2022) studied this question.
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