Issues Related to High-Sensitivity Troponin Assays

To the Editor:

In the recent article in Circulation Reports, entitled “Performance of the 0-Hour/1-Hour Algorithm for Diagnosing Myocardial Infarction in Patients With Chest Pain in the Emergency Department – A Systematic Review and Meta-Analysis”, Nomura et al.¹ conducted a meta-analysis of the diagnostic performance of the 0-hour/1-hour algorithm and reported results for high-sensitivity troponin (hs-Tn) I and T assays. We are concerned that there are some issues with hs-Tn assays.

First, the authors included the results of 6 studies on hs-TnI assay in their meta-analysis; 5 of these studies used the Abbott ARCHITECT hs-TnI assay and 1 used the Siemens Dimension Vista 1500 hs-TnI assay. However, hs-TnI assays have different cut-off values and diagnostic performance, and the diagnostic performance of the 0-hour/1-hour algorithms is assay specific. Therefore, a meta-analysis of studies using different hs-TnI assays is probably incorrect and the results of different hs-TnI assays should be reported separately.

Second, the authors stated that 2 studies used a fourth-generation hs-TnT assay for the 0-hour/1-hour algorithm, but the fourth-generation troponin T assay is not an hs-Tn assay and therefore cannot be applied to the 0-hour/1-hour algorithm.² It is probably an error for the fifth-generation troponin T.

Disclosures

M.T. has received non-financial support for research from Abbott Diagnostics Medical, Roche Diagnostics, and Siemens Healthcare Diagnostics. All other authors have no conflict of interest to declare.

• Masafumi Tada, MD
• Taku Ichihashi, MD, PhD
• Kenta Hachiya, MD, PhD
• Kentaro Yamada, MD, PhD
• Tomoaki Saeki, MD, PhD
• Department of Emergency Medicine, Neurology (M.T.), Department of Cardiology (T.I., K.H., T.S.), Department of Neurology (K.Y.), Nagoya City University East Medical Center, Nagoya; Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto (M.T.), Japan

References

• 1.   Nomura O, Hashiba K, Kikuchi M, Kojima S, Hanada H, Mano T, et al. Performance of the 0-hour/1-hour algorithm for diagnosing myocardial infarction in patients with chest pain in the emergency department: A systematic review and meta-analysis. Circ Rep 2022; 4: 241–247.
• 2.   Apple FS, Collinson PO; IFCC Task Force on Clinical Applications of Cardiac Biomarkers. Analytical characteristics of high-sensitivity cardiac troponin assays. Clin Chem 2012; 58: 54–61.