Key result
Adjusted cutoffs for three cardiac troponin I assays improved diagnostic accuracy for post-procedural MI, reaching 82% for type 5 MI and up to 88% for type 4a MI.
Why the study?
Different cardiac troponin I kits elicit different responses, making the diagnosis of post-procedural myocardial infarction challenging despite guideline recommendations.
Do new ROC cutoffs for contemporary and high-sensitivity cTnI assays improve the accuracy of diagnosing post-procedural MI compared to current guideline recommendations in patients undergoing PCI or CABG?
Observational (n=115)
Do new ROC cutoffs for contemporary and high-sensitivity cTnI assays improve the accuracy of diagnosing post-procedural MI compared to current guideline recommendations in patients undergoing PCI or CABG?
Current guideline-recommended cTnI cutoffs for post-procedural MI have low accuracy, but adjusting to new ROC-derived cutoffs improves diagnostic accuracy for both contemporary and high-sensitivity assays.
The myocardial infarction (MI) types 4a and 5 guidelines recommend cardiac troponin (cTn) diagnostic decision limits of 5 and 10 times the 99th percentile, respectively. Different cTn kits elicit different responses, so the MI diagnosis is still challenging. The study aimed to establish the cutoff values and the accuracy of three different cTnI kits in the diagnosis of post-procedural MI. We analyzed 115 patients with multivessel stable chronic coronary artery disease; 26 underwent percutaneous coronary intervention, and 89 underwent coronary artery bypass graft. Delayed-enhancement magnetic resonance imaging was performed before and after each intervention for definitive MI diagnoses. Two contemporary and one high-sensitivity cTnI immunoassays were used. ROC curves determined the accuracy of each assay. Low accuracy was observed after applying the current guidelines recommendations. The three cTnI assays accuracies improved when adjusted by the new ROC cutoffs, reaching 82% for MI type 5 for all assays, and 78%, 88%, and 87% for MI type 4 for Siemens, Beckman, and Abbott, respectively. The ultrasensitive and contemporary tests' accuracy for MI types 4a and 5 diagnoses are equivalent when adjusted for these new cutoffs. The hs-cTnI assays had lower accuracy than contemporary tests for MI types 4a and 5 diagnoses.
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Vendramini et al. (2023) conducted an observational in multivessel stable chronic coronary artery disease (n=115). Cardiac troponin I assays (Siemens, Beckman, Abbott) vs. Delayed-enhancement magnetic resonance imaging was evaluated on Accuracy in the diagnosis of post-procedural MI (types 4a and 5). Adjusted cutoffs for three cardiac troponin I assays improved diagnostic accuracy for post-procedural MI, reaching 82% for type 5 MI and up to 88% for type 4a MI.
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