The 99th percentile upper reference limit for the 5th generation cardiac troponin T assay in the United States

•Validation of 99th percentile URL for TnT Gen 5 assay in a healthy US population.•TnT Gen 5 results were higher in healthy males vs females and increased with age.•The findings facilitate interpretation of TnT Gen 5 results in US clinical practice. Determining diagnostic thresholds for cardiac troponin assays is key to interpreting their clinical performance. We describe the calculation of 99th percentile upper reference limits (URLs) for the Elecsys® Troponin T Gen 5 (TnT Gen 5) assay. Plasma and serum samples from healthy US participants were prospectively evaluated using TnT Gen 5 Short Turn Around Time and 18-min assays on cobas e 411 and cobas e 601 analyzers (Roche Diagnostics); with, up to 8 TnT Gen 5 results per participant. A total of 10,402 TnT Gen 5 results from 1301 participants were included (50.4% female). Across 9 calculation methods, overall 99th percentile URL was 19.2 ng/l (females, 13.5–13.6 ng/l; males, 21.4–22.2 ng/l). Across different sample/assay/analyzer combinations, overall 99th percentile URLs ranged from 18.4–20.2 ng/l. Median TnT Gen 5 results increased with age, were higher in males, and ranged from 3.0–3.7 ng/l across races/ethnicities and from 3.0–3.6 ng/l across body mass index (BMI) classes. Applying additional exclusion criteria (N-terminal pro-brain natriuretic peptide, BMI and estimated glomerular filtration rate) resulted in lower 99th percentile URLs (overall, 16.9 ng/l; females, 11.8 ng/l; males, 18.5 ng/l). Our findings facilitate the interpretation of TnT Gen 5 results in US clinical practice.