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Vessel Plus 2021;5:[Accepted].10.20517/2574-1209.2020.94@The Author(s) 2021
Accepted Manuscript
Open AccessOriginal Article

Assessment of agreement of two high sensitivity troponin assays during an institutional transition

Correspondence Address: Dr. Samuel McDonald, Department of Emergency Medicine 5323 Harry Hines Blvd, Dallas, TX 75390, USA. E-mail: samuel.mcdonald@utsouthwestern.edu


© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.


Aims: During a recent institutional transition between two high sensitivity troponin assays, we sought to evaluate the correlation and agreement in an unselected population presenting to the ED undergoing troponin measurement.


Methods: This was a prospective study of consecutive patients presenting to a single, academic institution that underwent troponin testing. Paired samples of two high sensitivity troponin assays, hs-cTnT (Gen 5 TnT; Roche Diagnostics, Indianapolis, IN) and hs-cTnI (High Sensitive Troponin I Architect i2000; Abbott, Abbott Park, Illinois) were assessed for overall correlation and agreement. We also evaluated the paired difference between the two assays stratified by gender and CKD stage. Further, we determined reclassification at the 99th percentile limit and the institutional established abnormal.


Results: A total of 1349 unique patient encounters were included in the study with median result value of 12.2 ng/L (IQR 6-29.5) for hs-cTnT and 4.7 ng/L (IQR 3.5-15.5) for hs-cTnI. Direct comparison of the two assays indicated a Spearman Rho of 0.79 with poor agreement especially when cTn results were elevated. Paired difference was smaller in women with a difference of medians of 0.9 ng/L (0.06-1.67, P < 0.01) and three significant clusters (CKD 1, CKD 2 and 3, CKD 4 and 5; P < 0.01) were found when stratifying by Chronic Kidney Disease stage Reclassification occurred in 276 patients when evaluated at the 99th percentile and 148 patients at the institution’s abnormal cut-off.


Conclusion: There was moderate correlation seen during our transition between the two high sensitivity troponins, but differential bias with lower hs-cTnI than hs-cTnT at low levels and higher hs-cTnI than hs-cTnT at high values. Without the appropriate system level recommendations and established diagnostic protocol this level of disagreement can potentially cause problems with interpretation to the end clinician who has become accustomed to a specific assay’s thresholds.

Cite This Article

McDonald S, Furmaga J, Vigen R, Muthukumar A, Hall HM, Turer A, Das SR, de Lemos JA, Diercks D. Assessment of Agreement Between Two High Sensitivity Troponin Assays During an Institutional Transition. Vessel Plus 2021;5:[Accept]. http://dx.doi.org/10.20517/2574-1209.2020.94 

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