Early kinetics of cardiac troponin in suspected acute myocardial infarction

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

doi:10.1016/j.rec.2020.04.008

Early kinetics of cardiac troponin in suspected acute myocardial infarction

Rev Esp Cardiol (Engl Ed). 2021 Jun;74(6):502-509. doi: 10.1016/j.rec.2020.04.008. Epub 2020 May 22.

[Article in English, Spanish]

Authors

María Rubini Giménez¹, Karin Wildi², Desiree Wussler³, Luca Koechlin⁴, Jasper Boeddinghaus³, Thomas Nestelberger⁵, Patrick Badertscher⁶, Raphael Sedlmayer⁵, Christian Puelacher³, Tobias Zimmermann⁵, Jeanne du Fay de Lavallaz³, Pedro Lopez-Ayala³, Kathrin Leu⁵, Katharina Rentsch⁷, Òscar Miró⁸, Beatriz López⁸, F Javier Martín-Sánchez⁹, José Bustamante⁹, Damian Kawecki¹⁰, Jiri Parenica¹¹, Jens Lohrmann¹², Wanda Kloos¹², Andreas Buser¹³, Dagmar I Keller¹⁴, Tobias Reichlin¹⁵, Raphael Twerenbold⁵, Christian Mueller¹⁶

Affiliations

¹ Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Cardiology, Heart Center Leipzig, Leipzig, Germany.
² Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Critical Care Research Institute, the Prince Charles Hospital, Brisbane and University of Queensland, Brisbane, Australia.
³ Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
⁴ Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Heart Surgery, University Hospital Basel, Basel, Switzerland.
⁵ Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
⁶ Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Cardiology, University of Illinois at Chicago, Chicago, United States.
⁷ Laboratory Medicine, University Hospital Basel, Basel, Switzerland.
⁸ Servicio de Urgencias, Hospital Clínic, Barcelona, Spain.
⁹ Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain.
¹⁰ 2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland.
¹¹ Department of Cardiology, University Hospital Brno, Brno, Czech Republic and Medical Faculty, Masaryk University, Brno, Czech Republic.
¹² Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Emergency Department, University Hospital Basel, Basel, Switzerland.
¹³ Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland and Department of Hematology, University Hospital Basel, Basel, Switzerland.
¹⁴ Emergency Department, University Hospital Zurich, Zurich, Switzerland.
¹⁵ Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁶ Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. Electronic address: [email protected].

PMID: 32451223
DOI: 10.1016/j.rec.2020.04.008

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).

Keywords: Acute myocardial infarction; Cardiac troponin release; Cinética de liberación linear; Infarto agudo de miocardio; Liberación de troponina cardiaca; Linear release kinetics.

Publication types

Multicenter Study

MeSH terms

Biomarkers
Humans
Kinetics
Myocardial Infarction* / diagnosis
Prospective Studies
Troponin I
Troponin T*

Substances

Biomarkers
Troponin I
Troponin T

Associated data

ClinicalTrials.gov/NCT00470587