Early kinetics of cardiac troponin in suspected acute myocardial infarction.

Abstract

INTRODUCTION AND OBJECTIVES:

Release kinetics of high-sensitivity cardiac troponin (hs-cTn) T and I in patients with acute myocardial infarction (AMI) are incompletely understood. We aimed to assess whether hs-cTnT/I release in early AMI is near linear.

METHODS:

In a prospective diagnostic multicenter study the acute release of hs-cTnT and hs-cTnI within 1 and 2hours from presentation to the emergency department was quantified using 3 hs-cTnT/I assays in patients with suspected AMI. The primary endpoint was correlation between hs-cTn changes from presentation to 1 hour vs changes from presentation to 2hours, among all AMI patients and different prespecified subgroups. The final diagnosis was adjudicated by 2 independent cardiologists, based on serial hs-cTnT from the serial study blood samples and additional locally measured hs-cTn values.

RESULTS:

Among 2437 patients with complete hs-cTnT data, AMI was the adjudicated diagnosis in 376 patients (15%). For hs-cTnT, the correlation coefficient between 0- to 1-hour change and 0- to 2 hour change was 0.931 (95%CI, 0.916-0.944), P <.001. Similar findings were obtained with hs-cTnI (Architect) with correlation coefficients between 0- to 1-hour change and 0- to 2 hour change of 0.969 and hs-cTnI (Centaur) of 0.934 (P <.001 for both). Findings were consistent among type 1 and type 2 AMI and in the subgroup of patients presenting very early after chest pain onset.

CONCLUSIONS:

Patients presenting with early AMI showed a near linear release of hs-cTnT and hs-cTnI. This near linearity provides the pathophysiological basis for rapid diagnostic algorithms using 0- to 1-hour changes as surrogates for 0- to 2 hour or 0- to 3 hour changes. Registered at ClinicalTrials.gov (Identifier: NCT00470587).

• Authors: María Rubini Giménez, Karin Wildi, Desiree Wussler, Luca Koechlin, Jasper Boeddinghaus, Thomas Nestelberger, Patrick Badertscher, Raphael Sedlmayer, Christian Puelacher, Tobias Zimmermann, Jeanne du Fay de Lavallaz, Pedro Lopez-Ayala, Kathrin Leu, Katharina Rentsch, Òscar Miró, Beatriz López, F Javier Martín-Sánchez, José Bustamante, Damian Kawecki, Jiri Parenica, Jens Lohrmann, Wanda Kloos, Andreas Buser, Dagmar I Keller, Tobias Reichlin, Raphael Twerenbold, Christian Mueller
• Journal: Revista espanola de cardiologia (English ed.) (Rev Esp Cardiol (Engl Ed)) Vol. 74 Issue 6 Pg. 502-509 (Jun 2021) ISSN: 1885-5857 [Electronic] Spain
• PMID: 32451223 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2020 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Chemical References

• Biomarkers
• Troponin I
• Troponin T

Topics

• Biomarkers
• Humans
• Kinetics
• Myocardial Infarction (diagnosis)
• Prospective Studies
• Troponin I
• Troponin T