scholarly journals Fentanyl Delays the Platelet Inhibition Effects of Oral Ticagrelor: Full Report of the PACIFY Randomized Clinical Trial

2018 ◽  
Vol 118 (08) ◽  
pp. 1409-1418 ◽  
Author(s):  
Khalil Ibrahim ◽  
Rohan Shah ◽  
Rakesh Goli ◽  
Thomas Kickler ◽  
William Clarke ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trial ◽  
Troponin I ◽  
Light Transmission ◽  
Myocardial Damage ◽  
Platelet Inhibition ◽  
Adverse Outcomes ◽  
Clinical Trial Registration ◽  
Time Curve ◽  
Platelet Aggregometry

Morphine delays oral P2Y12 platelet inhibitor absorption and is associated with adverse outcomes after myocardial infarction. Consequently, many physicians and first responders are now considering fentanyl as an alternative. We conducted a single-centre trial randomizing cardiac patients undergoing coronary angiography to intravenous fentanyl or not. All participants received local anaesthetic and intravenous midazolam. Those requiring percutaneous coronary intervention (PCI) with stenting received 180 mg oral ticagrelor intra-procedurally. The primary outcome was area under the ticagrelor plasma concentration–time curve (AUC0–24 hours). The secondary outcomes were platelet function assessed at 2 hours after loading, measured by P2Y12 reaction units (PRUs) and light transmission platelet aggregometry. Troponin-I was measured post-PCI using a high-sensitivity troponin-I assay (hs-TnI). All participants completed a survey of pain and anxiety. Of the 212 randomized, 70 patients required coronary stenting and were loaded with ticagrelor. Two participants in the no-fentanyl arm crossed over to receive fentanyl for pain. In as-treated analyses, ticagrelor concentrations were higher in the no-fentanyl arm (AUC0–24 hours 70% larger, p = 0.03). Platelets were more inhibited by 2 hours in the no-fentanyl arm (71 vs. 113 by PRU, p = 0.03, and 25% vs. 41% for adenosine diphosphate response by platelet aggregation, p < 0.01). Mean hs-TnI was higher with fentanyl at 2 hours post-PCI (11.9 vs. 7.0 ng/L, p = 0.04) with a rate of enzymatic myocardial infarction of 11% for fentanyl and 0% for no-fentanyl (p = 0.08). No statistical differences in self-reported pain or anxiety were found. In conclusion, fentanyl administration can impair ticagrelor absorption and delay platelet inhibition, resulting in mild excess of myocardial damage. This newly described drug interaction should be recognized by physicians and suggests that the interaction between opioids and oral P2Y12 platelet inhibitors is a drug class effect associated with all opioids. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02683707 (NCT02683707).

Comparison of methods to evaluate clopidogrel-mediated platelet inhibition after percutaneous intervention with stent implantation

2009 ◽  
Vol 101 (02) ◽  
pp. 333-339 ◽  
Author(s):  
Sabine Steiner ◽  
Daniela Seidinger ◽  
Renate Koppensteiner ◽  
Thomas Gremmel ◽  
Simon Panzer ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Light Transmission ◽  
Platelet Reactivity ◽  
Platelet Inhibition ◽  
Percutaneous Intervention ◽  
Adverse Outcomes ◽  
Gold Standard Method ◽  
Platelet Aggregometry ◽  
Increased Risk ◽  
The Impact

SummaryA high on-treatment residual ADP-inducible platelet reactivity in light transmission aggregometry (LTA) has been associated with an increased risk of adverse outcomes after percutaneous coronary intervention (PCI). However, LTA is weakly standardized, and results obtained in one laboratory may not be comparable to those obtained in another one. We therefore sought to determine the test correlating best with LTA to estimate clopidogrel-mediated platelet inhibition in 80 patients on dual antiplatelet therapy after elective percutaneous intervention with stent implantation. We selected the VerifyNow P2Y12 assay, the vasodilator-stimulated phosphoprotein phosphorylation assay, multiple electrode platelet aggregometry and the Impact-R for comparisons with LTA. Cut-off values for residual ADP-inducible platelet reactivity were defined according to quartiles of each assay. Sensitivities and specificities of the different platelet function tests were based on the results from LTA. The results from all four assays correlated significantly with those from LTA. The VerifyNow P2Y12 assay revealed the strongest correlation (r = 0.61, p < 0.001). Sensitivities and specificities ranged from 35% to 55%, and from 78.3% to 85%, respectively. In conclusion, although all assays correlated significantly with LTA, they need to be improved to become clinically used diagnostic tests. Further, it may be too early to define the gold standard method for assessing residual ADP-inducible platelet reactivity and generally acceptable cut-off values.

Circulating Erythrocyte Microparticles and the Biochemical Extent of Myocardial Injury in ST Elevation Myocardial Infarction

Cardiology ◽  
2016 ◽  
Vol 136 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Georgios Giannopoulos ◽  
Dimitrios A. Vrachatis ◽  
Georgios Oudatzis ◽  
Georgios Paterakis ◽  
Christos Angelidis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Injury ◽  
Troponin I ◽  
Multivariable Analysis ◽  
Area Under The Curve ◽  
Myocardial Damage ◽  
Primary Angioplasty ◽  
St Elevation Myocardial Infarction ◽  
Vascular Effects ◽  
St Elevation

Objectives: Red blood cell microparticles (RBCm) have potential adverse vascular effects and they have been shown to be elevated in ST elevation myocardial infarction (STEMI). The purpose of this study is to investigate their relationship with biochemical infarct size. Methods: RBCm were quantified with flow cytometry in blood drawn from 60 STEMI patients after a primary angioplasty. The creatine kinase-myocardial brain fraction (CK-MB) was measured at predefined time points and the area under the curve (AUC) was calculated. Results: RBCm count was correlated with CK-MB AUC (Spearman's ρ = 0.83, p < 0.001). The CK-MB AUC values per RBCm quartile (lower to upper) were: 3,351 (2,452-3,608), 5,005 (4,450-5,424), 5,903 (4,862-10,594), and 8,406 (6,848-12,782) ng × h/ml, respectively. From lower to upper quartiles, the maximal troponin I values were: 42.2 (23.3-49.3), 49.6 (28.8-54.1), 59.2 (41.4-77.3), and 69.1 (48.0-77.5) ng/ml (p = 0.005). In multivariable analysis, RBCm remained a significant predictor of CK-MB AUC (standardized β = 0.63, adjusted p = 0.001). Conclusions: Erythrocyte microparticles appear to be related to the total myocardial damage biomarker output. The exact pathophysiologic routes, if any, for this interaction remain to be identified. However, these results suggest that erythrocytes may be a - thus far virtually ignored - player in the pathogenesis of ischemic injury.

scholarly journals P669 Functional remodeling of the left atrium after first acute ST-elevation myocardial infarction: a 3D echocardiography study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Jarjour ◽  
S Civera ◽  
A Vijiiac ◽  
B Elnagar ◽  
C Palermo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Atrium ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Troponin I ◽  
Myocardial Damage ◽  
St Elevation Myocardial Infarction ◽  
P Value ◽  
Functional Remodeling ◽  
St Elevation

Abstract Background Left atrium (LA) is a dynamic structure which is functionally coupled with the left ventricle and modulates its function in many cardiac conditions. The geometric and functional remodeling of the LA occurring early after myocardial infarction are poorly understood. Purpose We sought to evaluate the early changes in LA geometry and function occurring in survivors of a first acute ST-elevation myocardial infarction (STEMI), using three-dimensional echocardiography (3DE). Methods LA phasic volumes and strain (both longitudinal and circumferential) were measured using a dedicated automated software package in 54 patients at pre-discharge after STEMI, and in 54 age- and sex-matched healthy volunteers (controls), (figure 1). Results In STEMI patients, both maximal (LAV max) and minimal (LAV min) LA volumes were significantly larger than in controls 63 ± 15 vs. 53 ±11 ml; p = 0,002 and 38 ± 15 ml vs. 25 ± 6; p &lt;0.0001 (respectively). Moreover, when compared to controls (Table 1). Both longitudinal (LASr) and circumferential strain reservoirs showed a significant negative correlation with peak cardiac troponin I values (r=-0.344; p = 0.007 and r=-0.357; p = 0.005, respectively) as an estimate of the extent of myocardial damage. Conclusion STEMI was associated to significant geometrical and functional remodeling of the LA which was correlated with the extent of myocardial damage. Table 1 Controls STEMI patients P-value Longitudinal% LASr 21.8 ± 8.4 13.72 ± 8.27 &lt;0.0001 LAScd -12.8 ± 8.48 -6.43 ± 4.74 &lt;0.0001 LASct -9.73 ± 6.04 -7.26 ± 5.87 0.05 Circumferential % LASr-c 27.31 ± 8.07 18.92 ± 9.16 &lt;0.0001 LAScd-c -11.2 ± 5.93 -6.46 ± 5.68 0.0002 LASct-c -16.22 ± 6.33 -12.41 ± 5.94 0.004 LASr longitudinal strain reservoir, LAScd: longitudinal strain conduit, LAScd: longitudinal strain contraction, LASr-c: circumferential strain reservoir, LAScd-c: circumferential strain conduit , LASct-c:circumferential strain contraction Abstract P669 Figure 1

Early and Delayed Myocardial Infarction after Abdominal Aortic Surgery

2005 ◽  
Vol 102 (5) ◽  
pp. 885-891 ◽  
Author(s):  
Yannick Le Manach ◽  
Azriel Perel ◽  
Pierre Coriat ◽  
Gilles Godet ◽  
Michèle Bertrand ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Troponin I ◽  
Aortic Surgery ◽  
Myocardial Damage ◽  
Abdominal Aortic Surgery ◽  
Abdominal Aortic ◽  
Rate Of Increase ◽  
Postoperative Myocardial Infarction ◽  
The Mean ◽  
Mean Time

Background Although postoperative myocardial infarction (PMI) after vascular surgery has been described to be associated with prolonged ischemia, its exact pathophysiology remains unclear. Methods The authors used intense cardiac troponin I (cTnI) surveillance after abdominal aortic surgery in 1,136 consecutive patients to better evaluate the incidence and timing of PMI (cTnI &gt; or = 1.5 ng/ml) or myocardial damage (abnormal cTnI &lt; 1.5 ng/ml). Results Abnormal cTnI concentrations was noted in 163 patients (14%), of which 106 (9%) had myocardial damage and 57 (5%) had PMI. In 34 patients (3%), PMI was preceded by a prolonged (&gt; 24 h) period of increased cTnI (delayed PMI), and in 21 patients (2%), the increase in cTnI lasted less than 24 h (early PMI). The mean times from end of surgery to PMI were 37 +/- 22 and 74 +/- 39 h in the early PMI and delayed PMI groups, respectively (P &lt; 0.001). The mean time between the first abnormal cTnI and PMI in the delayed PMI group was 54 +/- 35 h, during which the cTnI profiles of the myocardial damage and delayed PMI groups were identical. In-hospital mortality rates were 24, 21, 7, and 3% for the early PMI, delayed PMI, myocardial damage, and normal groups, respectively. Conclusions Intense postoperative cTnI surveillance revealed two types of PMI according to time of appearance and rate of increase in cTnI. The identification of early and delayed PMI may be suggestive of different pathophysiologic mechanisms. Abnormal but low postoperative cTnI is associated with increased mortality and may lead to delayed PMI.

scholarly journals Avoiding Routine Oxygen Therapy in Patients With Myocardial Infarction Saves Significant Expenditure for the Health Care System—Insights From the Randomized DETO2X-AMI Trial

2022 ◽  
Vol 9 ◽  
Author(s):  
Robin Hofmann ◽  
Tamrat Befekadu Abebe ◽  
Johan Herlitz ◽  
Stefan K. James ◽  
David Erlinge ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Health Care ◽  
Clinical Trial ◽  
Health Care System ◽  
Oxygen Therapy ◽  
Cost Savings ◽  
Ambient Air ◽  
Clinical Trial Registration ◽  
Study Population ◽  
Care System

Background: Myocardial infarction (MI) occurs frequently and requires considerable health care resources. It is important to ensure that the treatments which are provided are both clinically effective and economically justifiable. Based on recent new evidence, routine oxygen therapy is no longer recommended in MI patients without hypoxemia. By using data from a nationwide randomized clinical trial, we estimated oxygen therapy related cost savings in this important clinical setting.Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial randomized 6,629 patients from 35 hospitals across Sweden to oxygen at 6 L/min for 6–12 h or ambient air. Costs for drug and medical supplies, and labor were calculated per patient, for the whole study population, and for the total annual care episodes for MI in Sweden (N = 16,100) with 10 million inhabitants.Results: Per patient, costs were estimated to 36 USD, summing up to a total cost of 119,832 USD for the whole study population allocated to oxygen treatment. Applied to the annual care episodes for MI in Sweden, costs sum up to between 514,060 and 604,777 USD. In the trial, 62 (2%) patients assigned to oxygen and 254 (8%) patients assigned to ambient air developed hypoxemia. A threshold analysis suggested that up to a cut-off of 624 USD spent for hypoxemia treatment related costs per patient, avoiding routine oxygen therapy remains cost saving.Conclusions: Avoiding routine oxygen therapy in patients with suspected or confirmed MI without hypoxemia at baseline saves significant expenditure for the health care system both with regards to medical and human resources.Clinical Trial Registration:ClinicalTrials.gov, identifier: NCT01787110.

scholarly journals Acute myocardial damage in new coronavirus infection (COVID-19)

2021 ◽  
Vol 20 (5) ◽  
pp. 98-104
Author(s):  
N. V. Izmozherova ◽  
A. A. Popov ◽  
A. I. Tsvetkov ◽  
M. A. Shambatov ◽  
I. P. Antropova ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Medical Care ◽  
Myocardial Injury ◽  
Troponin I ◽  
Myocardial Damage ◽  
True Incidence ◽  
Wide Range ◽  
Acute Myocardial Injury ◽  
Coronavirus Infection

Introduction. Acute respiratory distress syndrome (ARDS) and cardiovascular events, acute myocardial injury being the most frequent of the latter, are among the leading causes of death in COVID-19 patients. The lack of consensus on acute myocardial injury pathogenesis mechanisms, the patients management, treatment an rehabilitation logistics, the anticoagulant treatment in identified SARS-CoV-2 or suspected COVID-19 patients setting indicates the need to assess, analyze and summarize the available data on the issue.Materials and methods. Scientific publications search was carried out in PubMed, Google Scholar databases for the period from December 2019 to September 2021.Results and Discussion. Cardiospecific troponin I increase beyond reference limits is reported to occur in at least every tenth patient with identified SARS-CoV-2, the elevated troponin detection rate increasing among persons with moderate to severe course of the infection. The mechanisms of acute myocardial injury in patients with COVID-19 are poorly understood. By September 2021, there are several pathogenesis theories. A high frequency viral myocarditis direct cardiomyocytes damage is explained by the high SARS-CoV-2 affinity to ACE2 expressed in the myocardium. The cytokine storm related myocardial damage is reported a multiple organ failure consequence. Coagulopathy may also trigger myocardial microvessels damage. Up to every third death of SARS-CoV-2 infected persons is related to the acute myocardial injury. At the same time, due to the high incidence of the acute myocardial injury, it is rather difficult to assess the true incidence of acute myocardial infarction in patients with COVID-19. In the pandemic setting, the waiting time for medical care increases, the population, trying to reduce social contacts, is less likely to seek medical help. In this regard, in order to provide effective medical care to patients with acute myocardial infarction, it is necessary to develop algorithms for providing care adapted to the current epidemiological situation.Conclusion. The treatment of patients with probable development of acute myocardial damage against the background of new coronavirus infection should be performed in accordance with the current clinical guidelines. Anticoagulant therapy should be administered in a prophylactic dose under control of hemostasis parameters and a wide range of biochemical parameters.

scholarly journals Takotsubo Syndrome: Is This a Common Occurrence in Elderly Females after Hip Fracture?

2020 ◽  
Vol 6 (3) ◽  
pp. 146-151
Author(s):  
Carlo Rostagno ◽  
Gianluca Polidori ◽  
Alice Ceccofiglio ◽  
Alessandro Cartei ◽  
Alberto Boccaccini ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hip Fracture ◽  
Troponin I ◽  
Myocardial Damage ◽  
Rank Test ◽  
Takotsubo Syndrome ◽  
Long Term Prognosis ◽  
Student’S T ◽  
One Year ◽  
Ecg Abnormalities

AbstractBackgroundThe prevalence of Takotsubo syndrome in hip fracture is not known.MethodsHip fracture patients were evaluated in a multidisciplinary unit. Patients with ECG abnormalities and increased troponin I values at the time of hospital admission were included in the study Follow-up was clinical at 30 days and by telephonic interview at one year.ResultsBetween October 1st 2011 to September 30th 2016, 51 of 1506 patients had preoperative evidence of myocardial damage. Eight, all females, fulfilled the Mayo criteria for Takotsubo syndrome, six had no coronary lesions. Hip surgery was uneventful, and all eight were alive at thirty days, and seven of these were still alive after one year. Forty-three patients had myocardial infarction: mortality at thirty days and one year were 11% and 44% (p<0.0001, Student’s t-test; log-rank test).ConclusionAt least 15% of patients with hip fracture and preoperative myocardial damage had Takotsubo syndrome. They were all elderly females. Contrary to myocardial infarction, Takotsubo syndrome has a favourable long term prognosis.

scholarly journals Ticagrelor in Acute Coronary Syndromes

2021 ◽  
Author(s):  
◽  
Charlotte Howard
Keyword(s):  
Myocardial Infarction ◽  
Real World ◽  
Platelet Reactivity ◽  
Controlled Trial ◽  
Platelet Inhibition ◽  
Adverse Outcomes ◽  
Risk Scores ◽  
Coronary Syndrome ◽  
Clinical Risk ◽  
P2y12 Receptor Antagonist

<p>The PLATO trial demonstrated significantly lower mortality and myocardial infarction in acute coronary syndrome (ACS) patients treated with ticagrelor and aspirin compared to clopidogrel and aspirin. Ticagrelor is a direct acting P2Y12 receptor antagonist, and is a more potent inhibitor of platelet reactivity than clopidogrel, and this is believed to be the main cause of its superior efficacy in the PLATO trial. A range of factors have been associated with high on-treatment platelet reactivity (HOTPR) on clopidogrel, including genetic factors, drug interactions and clinical risk factors. HOTPR on clopidogrel has been associated with a higher risk of adverse outcomes following ACS. On the basis of the PLATO trial results, and the theoretical limitations associated with clopidogrel, ticagrelor was funded by PHARMAC in July 2013, and has been recommended for use in patients with ACS in New Zealand.    This thesis examined the use of ticagrelor in a real world ACS population being managed through Wellington Hospital cardiology department. We examined platelet reactivity in patients treated with ticagrelor compared to clopidogrel, factors associated with clinician choice to use ticagrelor versus clopidogrel and the incidence of side effects of ticagrelor that may have implications for compliance with the drug outside the setting of a randomized controlled trial.   We found that ticagrelor significantly reduced both platelet reactivity (30.3 AU ± 17.5 versus 43.7 AU ± 24.8, p= 0.0001) and the proportion of patients classified as having HOTPR (15.9% versus 37.7%, p= 0.0001), in comparison to clopidogrel. The clinical variables associated with HOTPR differ between clopidogrel and ticagrelor, suggesting that different factors were driving residual platelet reactivity on the two agents.   Over a 2 year period, clopidogrel (68%) was used more commonly than ticagrelor (42%), and in a different cohort of patients. Patients treated with ticagrelor were younger (61 years ± 10 versus 65 years ± 12, p=0.0001), less likely to present with STEMI (12% versus 31%, p=0.0001), less likely to have a history of prior myocardial infarction (15.8% versus 22.7%, p=0.05), and had lower GRACE (98 ± 24 versus 108 ± 28, p=0.0001) and CRUSADE (25 ± 9 versus 28 ± 12, p=0.001) risk scores compared to those treated with clopidogrel. Prescription of ticagrelor was therefore not driven by clinical risk. Antiplatelet prescription varied significantly according to the patients’ admitting hospital.   Bleeding rates on ticagrelor and clopidogrel within 30 days of study enrolment were low and were not significantly different. There was 1 patient on clopidogrel who had the drug discontinued due to bleeding. At 30 day follow up, significantly more patients treated with ticagrelor reported dyspnoea (43.3% versus 27.1%, p=0.001), however discontinuation of the drug due to dyspnoea on ticagrelor was infrequent (1.7%).   In this real world cohort of ACS patients, we observed that ticagrelor was associated with more potent platelet inhibition than clopidogrel, but was not associated with factors leading to increased discontinuation at 30 days. Despite the proven benefits of ticagrelor compared to clopidogrel, the majority of patients, including the highest risk patients appear to be preferentially treated with clopidogrel. The causes contributing to underuse of ticagrelor need to be examined and addressed.</p>

scholarly journals Sundarban Honey Confers Protection against Isoproterenol-Induced Myocardial Infarction in Wistar Rats

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Rizwana Afroz ◽  
E. M. Tanvir ◽  
Nurul Karim ◽  
Md. Sabir Hossain ◽  
Nadia Alam ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Troponin I ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Peroxide ◽  
Myocardial Damage ◽  
Lipoprotein Cholesterol ◽  
Albino Rats ◽  
Marker Enzyme ◽  
Creatine Kinase Mb

The present study was designed to investigate the cardioprotective effects of Sundarban honey (SH) in rats with isoproterenol- (ISO-) induced myocardial infarction. Adult male Wistar Albino rats were pretreated with Sundarban honey (5 g/kg) daily for a period of 6 weeks. After the treatment period, ISO (85 mg/kg) was subcutaneously injected into the rats at 24 h intervals for 2 days. ISO-induced myocardial damage was indicated by increased serum cardiac specific troponin I levels and cardiac marker enzyme activities including creatine kinase-MB, lactate dehydrogenase, aspartate transaminase, and alanine transaminase. Significant increases in serum total cholesterol, triglycerides, and low-density lipoprotein-cholesterol levels were also observed, along with a reduction in the serum high-density lipoprotein-cholesterol level. In addition to these diagnostic markers, the levels of lipid peroxide products were significantly increased. The activities of antioxidant enzymes such as superoxide dismutase, glutathione peroxidase, and glutathione reductase were significantly decreased in the hearts after ISO-induced myocardial infarction. However, pretreatment of ischemic rats with Sundarban honey brought the biochemical parameters to near normalcy, indicating the protective effect of Sundarban honey against ISO-induced ischemia in rats. Histopathological findings of the heart tissues further confirmed the biochemical findings, indicating that Sundarban honey confers protection against ISO-induced oxidative stress in the myocardium.

scholarly journals Evaluation of Four Rapid Immunochromatographic Tests for the Detection of Cardiac Troponin I

2011 ◽  
Vol 18 (3) ◽  
pp. 414-417 ◽  
Author(s):  
Lovasoa Ramparany ◽  
José Ramirez ◽  
Jacques-Yves Nizou ◽  
David Le Saux ◽  
Vincent Richard ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Developing Countries ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Limit Of Detection ◽  
Myocardial Damage ◽  
Developed Countries ◽  
Cardiac Troponin I ◽  
Specific Marker ◽  
And Performance

ABSTRACTCardiac troponin I (cTnI) is a sensitive and specific marker of acute coronary syndromes and myocardial damage. During the past few years, it has become the preferred biochemical marker of myocardial infarction. However, due to the sensitivity required for its detection, only automated systems can be used in developed countries. However, these are rather expensive and unaffordable for most laboratories in developing countries. Many manufacturers have therefore proposed rapid immunochromatographic tests to detect cTnI. The aim of this study was to assess the limit of detection (LOD) and performance of four rapid immunochromatographic tests available in Madagascar. The four tests evaluated were Hexagon Troponin, Nadal troponin I cassette, Troponitest+, and Amicheck-Trop. Amicheck-Trop had a sensitivity and negative predictive value of about 80%, whereas for the three others, they were about 20%. The specificity of Amicheck-Trop of 87.3% was lower than the specificities of the other tests (98% to 100%). These differences were explained by the limits of detection of the tests: 0.3 to 0.4 ng/ml for Amicheck-Trop but only 1.8 to 2 ng/ml for the three other tests. It was concluded that Amicheck-Trop could be useful in the management of acute myocardial infarction or myocarditis in sparsely equipped laboratories in developing countries.

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