Early kinetics of cardiac troponin in suspected acute myocardial infarction.

Rubini Giménez, María; Wildi, Karin; Wussler, Desiree; Koechlin, Luca; Boeddinghaus, Jasper; Nestelberger, Thomas; Badertscher, Patrick; Sedlmayer, Raphael; Puelacher, Christian; Zimmermann, Tobias; du Fay de Lavallaz, Jeanne; Lopez-Ayala, Pedro; Leu, Kathrin; Rentsch, Katharina; Miró, Òscar; López, Beatriz; Martín-Sánchez, F Javier; Bustamante, José; Kawecki, Damian; Parenica, Jiri; ... (2021). Early kinetics of cardiac troponin in suspected acute myocardial infarction. Revista española de cardiología (English ed.), 74(6), pp. 502-509. Elsevier 10.1016/j.rec.2020.04.008

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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).

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