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Near-linearity of release of cardiac troponin in early acute myocardial infarction
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)
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
,
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.
In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
