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Vol. 74. Issue 6.
Pages 502-509 (June 2021)
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Vol. 74. Issue 6.
Pages 502-509 (June 2021)
Original article
Early kinetics of cardiac troponin in suspected acute myocardial infarction
Cinética temprana de troponina en pacientes con sospecha de infarto agudo de miocardio
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María Rubini Giméneza,b,, Karin Wildia,c,, Desiree Wusslera,d, Luca Koechlina,e, Jasper Boeddinghausa,d, Thomas Nestelbergera, Patrick Badertschera,f, Raphael Sedlmayera, Christian Puelachera,d, Tobias Zimmermanna, Jeanne du Fay de Lavallaza,d, Pedro Lopez-Ayalaa,d, Kathrin Leua, Katharina Rentschg, Òscar Miróh, Beatriz Lópezh, F. Javier Martín-Sánchezi, José Bustamantei, Damian Kaweckij, Jiri Parenicak, Jens Lohrmanna,l, Wanda Kloosa,l, Andreas Buserm, Dagmar I. Kellern, Tobias Reichlina,o, Raphael Twerenbolda, Christian Muellera,
Corresponding author
Christian.Mueller@usb.ch

Corresponding author: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
a Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
b Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
c Critical Care Research Institute, the Prince Charles Hospital, Brisbane and University of Queensland, Brisbane, Australia
d Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
e Department of Heart Surgery, University Hospital Basel, Basel, Switzerland
f Department of Cardiology, University of Illinois at Chicago, Chicago, United States
g Laboratory Medicine, University Hospital Basel, Basel, Switzerland
h Servicio de Urgencias, Hospital Clínic, Barcelona, Spain
i Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain
j 2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland
k Department of Cardiology, University Hospital Brno, Brno, Czech Republic and Medical Faculty, Masaryk University, Brno, Czech Republic
l Emergency Department, University Hospital Basel, Basel, Switzerland
m Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland and Department of Hematology, University Hospital Basel, Basel, Switzerland
n Emergency Department, University Hospital Zurich, Zurich, Switzerland
o Department of Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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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:
Cardiac troponin release
Acute myocardial infarction
Linear release kinetics
Abbreviations:
AMI
ED
Hs-cTn
NSTEMI
STEMI
Resumen
Introducción y objetivos

La cinética de liberación de troponinas cardiacas ultrasensibles (Tnc-us) T e I en pacientes con sospecha de infarto agudo de miocardio (IAM) se desconoce completamente a día de hoy. Nuestro objetivo fue evaluar si la liberación de Tnc-us T/I en las fases iniciales del IAM sigue un patrón linear.

Métodos

Estudio multicéntrico prospectivo diagnóstico donde se evaluó la liberación aguda de Tnc-us T/I durante la primera y segunda hora tras la presentación en servicios de urgencias utilizando 3 ensayos diferentes de Tnc-us T/I en pacientes con sospecha de IAM. El objetivo principal del estudio fue la correlación entre los cambios de valores de Tnc-us durante la presentación y 1h con respecto a los cambios durante la presentación y 2h en pacientes con IAM y diferentes subgrupos pre-especificados. El diagnóstico final fue adjudicado por 2 cardiólogos independientes, basándose en los valores seriados de Tnc-us T de las muestras del estudio y los valores adicionales de Tnc-us utilizados localmente.

Resultados

Entre los 2.437 pacientes con todas las muestras disponibles de Tnc-usT, el IAM fue el diagnóstico final en 376 pacientes (15%). Para Tnc-usT el coeficiente de correlación entre los cambios 0/1h y 0/2h fue 0,931 (IC95%, 0,916-0,944), p <0,001. Resultados similares se obtuvieron con Tnc-usI (Architect) con coeficiente de correlación de 0,969 y con Tnc-usI (Centaur) con coefficiente de correlación de 0,934 (p <0,001 para los dos). Los resultados fueron consistentes entre los IAM tipo 1 y 2 y entre el subgrupo de pacientes con una presentación temprana tras el inicio del dolor torácico.

Conclusiones

Pacientes que presentan en la fase temprana de IAM muestran una linearidad en la liberación de Tnc-usT y Tnc-usI. Esta linearidad ofrece la base fisiopatológica para usar con seguridad los algoritmos 0/1h anticipando los cambios que se producirán durante 0/2h y 0/3h.

Registrado en ClinicalTrials.gov (Identificador: NCT00470587).

Palabras clave:
Liberación de troponina cardiaca
Infarto agudo de miocardio
Cinética de liberación linear

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