Disagreement between Cardiac Troponin Tests Yielding a Higher Incidence of Myocardial Injury in the Emergency Setting

Peter A Kavsak; Shawn E Mondoux; Janet Martin; Mark K Hewitt; Lorna Clark; Nadia Caruso; Ching-Tong Mark; V Tony Chetty; Craig Ainsworth; Andrew Worster

doi:10.3390/jcdd8030031

Disagreement between Cardiac Troponin Tests Yielding a Higher Incidence of Myocardial Injury in the Emergency Setting

J Cardiovasc Dev Dis. 2021 Mar 23;8(3):31. doi: 10.3390/jcdd8030031.

Authors

Peter A Kavsak^{1

2}, Shawn E Mondoux³, Janet Martin¹, Mark K Hewitt³, Lorna Clark², Nadia Caruso², Ching-Tong Mark², V Tony Chetty^{1

2}, Craig Ainsworth⁴, Andrew Worster³

Affiliations

¹ Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada.
² Hamilton Regional Laboratory Medicine Program, Juravinski Hospital, Hamilton, ON L8V 1C3, Canada.
³ Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada.
⁴ Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada.

Abstract

Differences in patient classification of myocardial injury between high-sensitivity cardiac troponin (hs-cTn) assays have largely been attributed to assay design and analytical sensitivity aspects. Our objective was to compare Ortho Clinical Diagnostics' (OCD) hs-cTnI assay to OCD's contemporary/conventional assay (cTnI ES) and another hs-cTnI assay (Abbott hs-cTnI) in samples obtained from different emergency departments (EDs). Two different sample types were evaluated (lithium heparin and ethylenediaminetetraacetic acid (EDTA) plasma) in a non-selected ED population (study 1, n = 469 samples) and in patients for which ED physicians ordered cardiac troponin testing (study 2, n = 1147 samples), from five different EDs. The incidence of injury in study 1 was higher with the OCD hs-cTnI assay (30.9%; 95% CI: 26.9 to 35.2) compared to that of the Abbott hs-cTnI (17.3%; 95% CI: 14.1 to 21.0) and the OCD cTnI ES (15.4%; 95% CI: 12.4 to 18.9) assays, with repeat testing identifying 4.8% (95% CI: 3.0 to 7.5) of the OCD hs-cTnI results with poor reproducibility. In study 2, 4.6% (95% CI: 3.5 to 6.0) of the results were not reported for the OCD hs-cTnI assay (i.e., poor reproducibility) with 12.7% (95%CI: 8.7 to 17.8) of the OCD hs-cTnI results positive for injury being negative for injury with the Abbott hs-cTnI assay. In summary, the OCD hs-cTnI assay yields higher rates of biochemical injury with a higher rate of poor reproducible results in different ED populations.

Keywords: emergency department; false positive; high-sensitivity cardiac troponin; myocardial injury.