Effect of older age on diagnostic and prognostic performance of high-sensitivity troponin T in patients presenting to an emergency department

Am Heart J. 2012 Nov;164(5):698-705.e4. doi: 10.1016/j.ahj.2012.08.003. Epub 2012 Oct 16.


Background: The effect of age on diagnostic and prognostic performance of high-sensitivity cardiac troponin T (hs-cTnT) has not been addressed adequately, so far.

Methods: High-sensitivity cardiac troponin T was measured serially in patients with acute symptoms presenting to our emergency department. We tested the diagnostic and prognostic performance of baseline and serial hs-cTnT concentrations related to age in all consecutive patients with acute coronary syndrome (ACS) (n = 342) or hs-cTnT increases not due to ACS (n = 442).

Results: Prevalence of elevated hs-cTnT in the study population was higher among patients ≥75 years compared with younger patients (89.1 % vs 73.3 %, hazard ratio [HR] 1.2, P < .0001). Elevated hs-cTnT was more likely due to ACS in the younger patients (HR 1.4, P = .001) and conversely more frequently due to non-ACS conditions in the elderly patients (HR 1.3, P = .0001). Diagnostic performance of hs-cTnT using the 99th percentile was significantly superior in younger than in elderly patients (P < .0001). For receiver operating characteristic-optimized cutoffs, a trend to significance was found between younger and older patients (area under the curve 0.87 vs 0.79, P = .074), with higher sensitivities (98.2 % vs 72.6%) and negative predictive values (97.3% vs. 78.5%) for patients <75 years. Moreover, receiver operating characteristic-optimized cutoff values for diagnosis of non-ST-segment elevation myocardial infarction were significantly higher in elderly patients (32.9 ng/L) compared with younger patients (12.9 ng/L). The prognostic information of single and serial hs-cTnT measurements was comparably poor in both age groups, showing no better prognostic information to hs-cTnT measurement on presentation.

Conclusions: Elevated hs-cTnT is more common in the elderly due to higher prevalence of non-ACS conditions and significantly impairs diagnostic performance in discriminating non-ST-segment elevation myocardial infarction.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Biomarkers / blood
  • Emergency Service, Hospital
  • Female
  • Heart Conduction System / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / blood*
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / physiopathology
  • Odds Ratio
  • Predictive Value of Tests
  • Prognosis
  • ROC Curve
  • Sensitivity and Specificity
  • Troponin T / blood*


  • Biomarkers
  • Troponin T