Is the 99th Percentile the Optimal Reference Limit to Diagnose Myocardial Infarction with High Sensitivity Cardiac Troponin Assays in Patients with Chronic Kidney Disease?
The estimated annual incidence of myocardial infarction in the United States is ~525,000 new attacks/year and ~210,000 recurrent attacks1. The large number of events results in many emergency room visits for diagnostic evaluation to determine presence or absence of acute coronary syndrome (ACS) and need for hospital admission. The Third Universal Definition of Myocardial Infarction requires abnormal cardiac biomarkers in the context of acute myocardial ischemia supported by clinical, ECG, or cardiac imaging findings2. Cardiac troponin is recommended as the preferred biomarker to document myocardial necrosis. A rise or fall of c-Tn with at least one value > 99th percentile of a reference control population using an assay with total imprecision at the 99th percentile <10% is recommended to meet biomarker criteria for types 1, 2 and 4b/c myocardial infarction (MI). For procedure related types 4a and 5 MI events, multiples > 99th percentile are recommended.
- Received April 16, 2015.
- Accepted April 17, 2015.