Discordance of High-Sensitivity Troponin Assays in Patients With Suspected Acute Coronary Syndromes

Júlia Karády, Thomas Mayrhofer, Maros Ferencik, John T. Nagurney, James E. Udelson, Andreas A. Kammerlander, Jerome L. Fleg, W. Frank Peacock, James L. Januzzi, Wolfgang Koenig, Udo Hoffmann

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background: High-sensitivity cardiac troponin (hs-cTn) assays have different analytic characteristics. Objectives: The goal of this study was to quantify differences between assays for common analytical benchmarks and to determine whether they may result in differences in the management of patients with suspected acute coronary syndrome (ACS). Methods: The authors included patients with suspected ACS enrolled in the ROMICAT (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) I and II trials, with blood samples taken at emergency department presentation (ROMICAT-I and -II) or at 2 and 4 h thereafter (ROMICAT-II). hs-cTn concentrations were measured using 3 assays (Roche Diagnostics, Elecsys 2010 platform; Abbott Diagnostics, ARCHITECT i2000SR; Siemens Diagnostics, HsVista). Per blood sample, we determined concordance across analytic benchmarks (<limit of detection [<LOD]/LOD-99th percentile/>99th percentile). Per-patient, the authors determined concordance of management recommendations (rule-out/observe/rule-in) per the 0/2-h algorithm, and their association with diagnostic test findings (coronary artery stenosis >50% on coronary computed tomography angiography or inducible ischemia on perfusion imaging) and ACS. Results: Among 1,027 samples from 624 patients (52.8 ± 10.0 years; 39.4% women), samples were classified as <LOD (56.3% vs. 10.4% vs. 41.2%; p < 0.001), LOD-99th percentile (36.5% vs. 83.5% vs. 52.6; p < 0.001), >99th percentile (7.2% vs. 6.0% vs. 6.2%) by Roche, Abbott, and Siemens, respectively. A total of 37.4% (n = 384 of 1,027) of blood samples were classified into the same analytical benchmark category, with low concordance across benchmarks (<LOD 11.1%; LOD-99th percentile 29.3%; >99th percentile 43.6%). Serial samples were available in 242 patients (40.1% women; mean age: 52.8 ± 8.0 years). The concordance of management recommendations across assays was 74.8% (n = 181 of 242) considering serial hs-cTn measurements. Of patients who were recommended to discharge, 19.6% to 21.1% had positive diagnostic test findings and 2.8% to 4.3% had ACS at presentation. Conclusions: Caregivers should be aware that there are significant differences between hs-cTn assays in stratifying individual samples and patients with intermediate likelihood of ACS according to analytical benchmarks that may result in different management recommendations.

Original languageEnglish (US)
Pages (from-to)1487-1499
Number of pages13
JournalJournal of the American College of Cardiology
Issue number12
StatePublished - Mar 30 2021


  • acute coronary syndrome
  • concordance
  • high-sensitivity cardiac troponin
  • high-sensitivity cardiac troponin assays

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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