High-sensitivity cardiac troponin I and T both demonstrated high diagnostic and prognostic accuracy for acute myocardial infarction, with small but potentially important differences.
Does high-sensitivity-cardiac troponin I differ from high-sensitivity-cardiac troponin T for the early diagnosis of acute myocardial infarction?
Both hs-cTnI and hs-cTnT offer high diagnostic and prognostic accuracy for acute myocardial infarction, though small differences exist that may refine their clinical application.
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.
“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.”
Giménez et al. (2014) studied this question. High-sensitivity cardiac troponin I and T both demonstrated high diagnostic and prognostic accuracy for acute myocardial infarction, with small but potentially important differences.