Imprecision of high-sensitivity cardiac troponin assays at the female 99th-percentile

Peter A Kavsak*, Lorna Clark, Saranya Arnoldo, Amy Lou, Jennifer L. Shea, Shaun Eintracht, Andrew W. Lyon, Vipin Bhayana, Laurel Thorlacius, Joshua E. Raizman, Albert Tsui, Rose Djiana, Michael Chen, Yun Huang, Ali Haider, Ronald A. Booth, Chris Mccudden, Paul M. Yip, Daniel R. Beriault, David BlankAngela W.s. Fung, Jennifer Taher, Julie St-Cyr, Sameer Sharif, Emilie Belley-cote, Beth L Abramson, Steven M. Friedman, Jafna L. Cox, Marco L.a. Sivilotti, Annabel Chen-Tournoux, Jesse Mclaren, Susanna Mak, Venkatesh Thiruganasambandamoorthy, Frank Scheuermeyer, Karin H Humphries, Andrew Worster, Dennis Ko, Kristin M Aakre, Nicholas L Mills, Allan S Jaffe

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: An analytical benchmark for high-sensitivity cardiac troponin (hs-cTn) assays is to achieve a coefficient of variation (CV) of ≤10.0% at the 99th percentile upper reference limit (URL) used for the diagnosis of myocardial infarction. Few prospective multicenter studies have evaluated assay imprecision and none have determined precision at the female URL which is lower than the male URL for all cardiac troponin assays.

Methods: Human serum and plasma matrix samples were constructed to yield hs-cTn concentrations near the female URLs for the Abbott, Beckman, Roche, and Siemens hs-cTn assays. These materials were sent (on dry ice) to 35 Canadian hospital laboratories (n=64 instruments evaluated) participating in a larger clinical trial, with instructions for storage, handling, and monthly testing over one year. The mean concentration, standard deviation, and CV for each instrument type and an overall pooled CV for each manufacturer were calculated.

Results: The CVs for all individual instruments and overall were ≤10.0% for two manufacturers (Abbott CVpooled=6.3% and Beckman CVpooled =7.0%). One of four Siemens Atellica instruments yielded a CV >10.0% (CVpooled =7.7%), whereas 15 of 41 Roche instruments yielded CVs >10.0% at the female URL of 9 ng/L used worldwide (6 cobas e411, 1 cobas e601, 4 cobas e602, and 4 cobas e801) CVpooled=11.7%). Four Roche instruments also yielded CVs >10.0% near the female URL of 14 ng/L used in the United States (CVpooled=8.5%).

Conclusions: The number of instruments achieving a CV ≤10.0% at the female 99th-percentile URL varies by manufacturer and by instrument. Monitoring assay precision at the female URL is necessary for some assays to ensure optimal use of this threshold in clinical practice.
Original languageEnglish
Article number110731
Number of pages6
JournalClinical Biochemistry
Early online date14 Feb 2024
Publication statusPublished - 1 Mar 2024

Keywords / Materials (for Non-textual outputs)

  • Imprecision
  • female 99th percentile
  • upper reference limit
  • high-sensitivity cardiac troponin


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