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Near-linearity of release of cardiac troponin in early acute myocardial infarction

Session Poster session 3

Speaker Maria Rubini Gimenez

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Non-ST-Elevation Myocardial Infarction (NSTEMI)
  • Session type : Poster Session

Authors : M Rubini Gimenez (Basel,CH), R Twerenbold (Basel,CH), J Boeddinghaus (Basel,CH), K Wildi (Basel,CH), T Nestelberger (Basel,CH), C Puelacher (Basel,CH), P Badertscher (Basel,CH), C Mueller (Basel,CH)

Authors:
M. Rubini Gimenez1 , R. Twerenbold1 , J. Boeddinghaus1 , K. Wildi1 , T. Nestelberger1 , C. Puelacher1 , P. Badertscher1 , C. Mueller1 , 1University Hospital Basel, Department of Cardiology - Basel - Switzerland ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 583

Background: Release kinetics of cardiac troponin T and I in patients with acute myocardial infarction (AMI) are incompletely understood. High-sensitivity cardiac troponin (hs-cTn) assays allow testing the hypothesis that cTnT/I release in early AMI is near-linear.

Methods: In a prospective diagnostic multicenter study release of cTnT and cTnI was quantified using absolute changes in hs-cTnT/I within 1h, 2h, and 3h from presentation to the emergency department using four hs-cTn assays in patients with suspected AMI. Findings were validated using three additional sensitive (s-cTn) assays. The final diagnosis was adjudicated by two independent cardiologists.

Results: Among 2437 patients with complete hs-cTnT data, AMI was the adjudicated diagnosis in 376 patients (15%). The correlation coefficient between 1h-change and 2h-change was 0.931 (p<0.001). Similar findings were obtained with three hs-cTnI assays with correlation coefficients between 1h-change and 2h-change ranging from 0.851 to 0.946 (p<0.001 for all) and validated with three additional s-cTnI assays (r=0.947 to 0.986, p<0.001). Findings were consistent among AMI subtypes, in the subgroup of patients presenting very early after chest pain onset, as well as for the correlation between 1h-change and 3h-change. Changes in cTnT and cTnI in patients with diagnoses other than AMI in general were much smaller, and correlation coefficients between 1h-change and 2h-change ranged from 0.701 to 0.967 (p<0.001 for all).

Conclusions: Patients presenting with early AMI show a near-linear release of cTnT and cTnI. This linearity provides the pathophysiological basis for rapid diagnostic algorithms using 1h-changes as reliable surrogates for 2h/3h-changes. Furthermore these findings seem to support the extension of the “time is muscle” concept from the treatment of patients with STEMI to also patients with NSTEMI.

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