Cardiology and CTVS

Diagnostic Performance Of Cardiac Troponin Influenced By Age, Finds Study

• byDoctor News Daily Team
• 18 February, 2025
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The diagnostic performance of cardiac troponin is influenced by Age as per a recent study. It showed reduced specificity and positive predictive value in older patients. The study was published in the journal Circulation.

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The 99th centile of cardiac troponin is generally used as the diagnostic threshold for myocardial infarction. But age is the strongest influencer for troponin concentrations. Researchers conducted a secondary analysis of a multicenter trial to assess the diagnostic performance of cardiac troponin in aged patients presenting with suspected myocardial infarction.

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The diagnostic accuracy of high-sensitivity cardiac troponin I at presentation for the diagnosis of type 1, type 2, or type 4b myocardial infarction across 3 age groups was done on consecutive patients with suspected myocardial infarction using guideline-recommended sex-specific and age-adjusted 99th centile thresholds. The three age groups were <50, 50–74, and ≥75 years.
Key findings:

In 46 435 consecutive patients aged 18 to 108 years with a mean age of 61 years.
There were 12 379 participants in <50 years, 22 380 participants from 50 to 74, and 11 676 participants in ≥75years age groups.
Of the total 5216 (11%) had a diagnosis of myocardial infarction.
In patients <50, 50 to 74, and ≥75 age groups, the sensitivity of the guideline-recommended threshold was similar at 79.2%, 80.6%, and 81.6%, respectively.
The specificity decreased with advancing age from 98.3% to 95.5%, and 82.6%.
The use of age-adjusted 99th centile thresholds improved the specificity (91.3% vs 82.6%) and positive predictive value (59.3% vs 51.5%) for myocardial infarction in patients ≥75 years but failed to prevent the decrease in either parameter with increasing age. This resulted in a marked reduction in sensitivity compared with the use of the guideline-recommended threshold (55.9% versus 81.6%).
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Thus, the researchers concluded that the diagnostic performance of cardiac troponin is altered by the age of the individuals for guideline-recommended or age-adjusted 99th centiles. They also recommended individualizing the diagnostic approaches rather than adjusting the binary thresholds in the aging population.
For full reading: 10.1161/CIRCULATIONAHA.122.059994
Lowry MTH, Doudesis D, Wereski R, et al. Influence of Age on the Diagnosis of Myocardial Infarction [published online ahead of print, 2022 Sep 15]. Circulation. 2022;101161CIRCULATIONAHA122059994.