Abstract 19710: Causes for Increased Cardiac Troponin I Using Gender-Specific 99th Percentiles From a High Sensitivity Assay in a US Population
Introduction: High-sensitivity cardiac troponin (hs-cTn) assays have not yet been FDA cleared for clinical use in the United States (US). Pending expected approval of hs-cTn assays, which will use gender-specific cutoffs (GSC), it is relevant to recognize the causes of cTn increases using hs-cTnI assays in a US population. Our purpose was to describe the frequency of distinct etiologies of hs-cTnI assay increases using GSC.
Methods: Retrospective study of 310 patients with serial hs-cTnI (Abbott ARCHITECT, 99th percentiles: F:16 ng/L; M:34 ng/L) measurements. Patients with an increased hs-cTnI were adjudicated into categories according to the 3rd Universal Definition of MI. Categories included, A: primary myocardial ischemia (i.e. plaque rupture); B: injury secondary to supply/demand imbalance; C: injury not related to myocardial ischemia (i.e. cardiac contusion, ablation, shock, surgery); D: multifactorial or indeterminate myocardial injury (i.e. heart failure, critically ill, pulmonary HTN, sepsis, stroke, renal failure, pulmonary embolism); E: Unknown.
Results: 127 (41%) had an increased hs-cTnI above the GSC 99th percentile, whereas 183 (59%) had a normal hs-cTnI. The most common causes of hs-cTnI increases were: a) multifactorial or indeterminate injury - 43% among all patients and 52% in males, and b) supply/demand imbalance - 39% in women (Table). Injury related to primary myocardial ischemia was present in 10% (n=13). Females had more injury related to supply/demand ischemia than males (39% vs. 18%, p=0.01), whereas males had more multifactorial or indeterminate injury (52% vs. 33%, p=0.05).
Conclusions: Most increased hs-cTnI values were explained by non-plaque rupture conditions. Males tended to have hs-cTnI increases due to multifactorial/indeterminate causes, whereas in women supply/demand imbalance was the most common etiology. Investigations are needed to better understand if etiologies of myocardial injury have gender differences.
Author Disclosures: Y. Sandoval: None. S.W. Smith: None. K.M. Schulz: None. M.M. Murakami: None. F.S. Apple: Research Grant; Modest; Research Grant Support as PI, no salary. Siemens Healthcare, Research Grant Support as PI, no salary. Abbott Diagnostics, Research Grant Support as PI, no salary. Trinity, Research Grant Support as PI, no salary. Roche Laboratories, Research Grant Support as PI, no salary. Ortho-Clinical Diagnostics, Research Grant Support as PI, no salary. Radiometer Medical, Research Grant Support as PI, no salary. Alere, Research Grant Support as PI, no salary. Davita Clinical Research, Research Grant Support as PI, no salary. Biomerieux, Research Grant Support as PI, no salary. Beckman Coulter. Honoraria; Modest; Abbott. Consultant/Advisory Board; Modest; Phillips. Consultant/Advisory Board; Significant; Instrumentation Laboratory.
- © 2014 by American Heart Association, Inc.