title: Evaluation of four sensitive troponin assays for risk assessment in acute coronary syndromes using a new clinically oriented approach for comparison of assays.
abstract: BACKGROUND
  Measurement of cardiac troponin T or I (cTnT; cTnI) is useful for risk prediction in acute coronary syndromes. The objective of the present study was to compare the prognostic capacity of four sensitive cardiac troponin assays using a new method for comparison.
  
  
  METHODS
  Cardiac troponin was analyzed in serum samples from 1335 patients with acute coronary syndrome using the Elecsys high sensitivity TnT (hs-cTnT), ARCHITECT STAT high sensitivity TnI (hs-cTnI), Access AccuTnI (Acc-cTnI) and Architect cTnI (Arc-cTnI) assays. All patients were followed for 30 days regarding death and acute myocardial infarction (AMI), and for 1 year regarding mortality.
  
  
  RESULTS
  By receiver operating characteristic (ROC) curve analyses, there were only minor differences in the area under the curves (AUC) between the assays. At a given sensitivity of 85% the hs-cTnT, Arc-cTnI and Acc-cTnI assays showed comparable specificities, while 90% or higher sensitivity was only possible to achieve with the hs-cTnT, hs-cTnI and Acc-cTnI assays. The highest odds ratios for death/AMI at 30 days and death at 1 year, respectively, were reached by cut-off levels yielding 95% sensitivity; these cut-off levels were below the respective 99th percentile levels.
  
  
  CONCLUSIONS
  By the adoption of a new method for the comparison of cardiac troponin assays we showed that the hs-cTnT, hs-cTnI and Acc-cTnI assays had comparable prognostic properties, while the Arc-cTnI assay had inferior prognostic sensitivity.
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
authors.forename: Kai M
authors.initials: KM
authors.lastname: Eggers
authors.forename: Per
authors.initials: P
authors.lastname: Venge
authors.forename: Stefan
authors.initials: S
authors.lastname: James
mesh_terms: D000077284:Abciximab; D054058:Acute Coronary Syndrome / Q000097:blood* / Q000188:drug therapy*; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001681:Biological Assay; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D014336:Troponin / Q000097:blood*
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D014336:Troponin; D000077284:Abciximab