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Early kinetics of cardiac troponin in suspected acute myocardial infarction.

Authors
  • Rubini Giménez, María1
  • Wildi, Karin2
  • Wussler, Desiree3
  • Koechlin, Luca4
  • Boeddinghaus, Jasper3
  • Nestelberger, Thomas5
  • Badertscher, Patrick6
  • Sedlmayer, Raphael5
  • Puelacher, Christian3
  • Zimmermann, Tobias5
  • du Fay de Lavallaz, Jeanne3
  • Lopez-Ayala, Pedro3
  • Leu, Kathrin5
  • Rentsch, Katharina7
  • Miró, Òscar8
  • López, Beatriz8
  • Martín-Sánchez, F Javier9
  • Bustamante, José9
  • Kawecki, Damian10
  • Parenica, Jiri11
  • And 7 more
  • 1 Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Department of Cardiology, Heart Center Leipzig, Leipzig, Germany. , (Switzerland)
  • 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. , (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. , (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. , (Switzerland)
  • 5 Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. , (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. , (Switzerland)
  • 7 Laboratory Medicine, University Hospital Basel, Basel, Switzerland. , (Switzerland)
  • 8 Servicio de Urgencias, Hospital Clínic, Barcelona, Spain. , (Spain)
  • 9 Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain. , (Spain)
  • 10 2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland. , (Poland)
  • 11 Department of Cardiology, University Hospital Brno, Brno, Czech Republic and Medical Faculty, Masaryk University, Brno, Czech Republic. , (Czechia)
  • 12 Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland; Emergency Department, University Hospital Basel, Basel, Switzerland. , (Switzerland)
  • 13 Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland and Department of Hematology, University Hospital Basel, Basel, Switzerland. , (Switzerland)
  • 14 Emergency Department, University Hospital Zurich, Zurich, Switzerland. , (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. , (Switzerland)
  • 16 Department of Cardiology and Cardiovascular Research, Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland. Electronic address: [email protected] , (Switzerland)
Type
Published Article
Journal
Revista espanola de cardiologia (English ed.)
Publication Date
Jun 01, 2021
Volume
74
Issue
6
Pages
502–509
Identifiers
DOI: 10.1016/j.rec.2020.04.008
PMID: 32451223
Source
Medline
Keywords
Language
Spanish
License
Unknown

Abstract

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. 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. 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. 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). Copyright © 2020 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

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