Absolute vs. Relative Delta High-Sensitivity Cardiac Troponin Measures in Patients with Acute Chest Pain

Document Type

Conference Proceeding

Publication Date

5-13-2025

Publication Title

Acad Emerg Med

Keywords

troponin, adult, cohort analysis, conference abstract, controlled study, diagnosis, diagnostic test accuracy study, electrocardiography, emergency ward, female, forest, heart infarction, human, major clinical study, male, middle aged, observational study, predictive value, ST segment elevation myocardial infarction, thorax pain

Abstract

Background and Objectives: Chest pain guidelines recommend measuring high sensitivity cardiac troponins (hs-cTn) and their serial change (delta) values. Data examining the utility of an absolute delta versus relative (percent) delta are limited. This study evaluates the diagnostic performance of absolute versus percent delta hs-cTnI measurements for myocardial infarction (MI) in a large multisite US cohort. Methods: We conducted an observational cohort study using the Wake Forest Chest Pain Registry. Patients ≥18 years old with chest pain, serial hs-cTnI measures, and without STEMI on ECG were accrued from five US Emergency Departments from 11/1/2020- 7/31/2022. Patients' 0-and 2-h hs-cTnI (Beckman Coulter) measures were used to determine delta values. Consistent with prior studies, elevated delta values were defined by an absolute delta value ≥10 ng/L or a relative delta of ≥20%. The primary outcome was MI at the index visit determined by validated ICD codes. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of elevated absolute and relative delta values for MI were assessed with associated 95% confidence intervals and compared using McNemar's tests or generalized score statistics. Results: During the study period, 12,845 patients with serial hs-cTnI measures were included, of which 51.6% (6,632/12,845) were female with a median age of 57 (IQR: 45-68) years. Index MI occurred in 7.5% (957/12,845). An absolute delta ≥10 ng/L occurred in 9.8% (1,260/12,845) of patients, yielding a sensitivity of 81.6% (95% CI: 79.0%-84.0%), specificity of 96.0% (95% CI: 95.6%-96.3%), NPV of 98.5% (95% CI: 98.2%-98.7%), and PPV of 62.0% (95% CI: 59.2%-64.7%) for index MI. A relative delta ≥20% occurred in 29.8% of patients, resulting in a sensitivity of 71.4% (95% CI: 68.4%-74.2%), specificity of 73.1% (95% CI: 72.3%-73.9%), NPV of 96.3% (95% CI: 95.9%-96.7%), and PPV of 16.3% (95% CI: 15.2%-17.6%) for index MI. Sensitivity, specificity, NPV, and PPV were significantly higher for the absolute delta compared to the relative delta (p < 0.001). Conclusion: An elevated absolute delta had higher sensitivity, specificity, NPV, and PPV for index MI compared to an elevated relative delta. This suggests that use of an absolute delta is preferred for the evaluation of patients with acute chest pain.

Volume

32

Issue

S1

First Page

76

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