sono necessari 99° percentili di troponina ad alta sensibilità (hs-cTn) specifici per etnia, età e sesso? Parte i: il peso dell’etnia e dell’età

Background: The Myocardial Markers Working Group of the Italian Society of Clinical Pathology and Laboratory Medicine (GdS-MM SIPMeL) issued Recommendations on the use of hs-cTn in NSTEMI, in which the topic of ethnicity-, age-, and sex-specific 99th percentiles was not fully addressed. The aim of the present research is to determine whether a solid evidence base exists to support Recommendations by the GdS MM SIPMeL for the use of ethnicity-, age-, and sex-specific 99th percentiles in Acute Coronary Syndrome (ACS). This Part One is devoted to ethnicity and age. Methods: The evidence search was implemented through systematic reviews conducted on PubMed (1/1/2010 - 31/10/2023). The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) selection method was applied to the literature search results. Results: The PubMed search to define the usefulness/need for ethnicity-specific 99th percentiles of hs-cTn in adulthood (search objective and inclusion criterion) yielded 16 articles. Of these, nine were included. The PubMed search for the utility/need for 99th age-specific percentiles of hs-cTn in adulthood (search objective and inclusion criterion) provided 164 articles. Four articles were added from other sources. Out of the total yielded, 33 were included, divided into two groups: 16 looked at ‘healthy’ populations to define the 99th percentile and the influence of age, and 17 looked at groups of patients with suspected ACS/AMI/NSTEMI to assess the efficacy of age-specific 99th percentiles. Conclusions: The data from the systematic reviews on the influence of ethnicity and age on troponin levels, measured by high-sensitivity assays, in healthy subjects, and thus on the 99th percentile, and on the usefulness of using ethnicity- and age-specific 99th percentiles are limited and conflicting (ethnicity) or conflicting and difficult to apply theoretically or practically (age) and do not allow an unequivocal conclusion. At present, there is no evidence to support Recommendations of the GdS-MM SIPMeL for ethnicity- and age-specific 99th percentiles of hs-cTn.