Utility of cardiac troponin I, creatine kinase-MBmass, myosin light chain 1, and myoglobin in the early in-hospital triage of "high risk" patients with chest pain

Introduction: It is well known that high density lipoprotein cholesterol is inversely correlated with the risk of coronary artery disease. However, data is limited regarding the relationship of high density lipoprotein cholesterol in the acute setting of coronary artery disease and particularly how it compares to the most well-known biomarker, cardiac troponin I. Hypothesis: We assessed the hypothesis that high density lipoprotein cholesterol could be used as an alternative marker to troponin for acute coronary syndrome (ACS) in high risk patients. Methods: We analysed 740 patients of the BRAVEHEART cohort presenting for coronary angiography at our institution between October 2009 and March 2014. Of these, 153 patients presented with ACS, including 44 with ST elevation myocardial infarction and 109 with non-ST elevation myocardial infarction, and 587 patients presented without ACS. Binary logistic regression was used to compare high density lipoprotein cholesterol and cardiac troponin I levels as predictors of ACS, independent of age, sex, cardiac risk factors and statin use. Results: Patients presenting with ACS had higher median cardiac troponin I levels (0.34 vs. 0.02 μg/L; p<0.001), higher median serum triglyceride levels (1.5 vs. 1.3 mmol/L, p<0.001) and lower median high density lipoprotein cholesterol levels (0.97 vs. 1.09 mmol/L, p<0.001) than patients without ACS. There was no difference in total cholesterol and low density lipoprotein cholesterol between the two groups. After adjusting for differences in patient variables, the strongest independent predictors of ACS were cardiac troponin I (odds ratio (OR), 1.50; 95% confidence interval (CI), 1.24-1.82; p<0.001) and high density lipoprotein cholesterol (OR, 0.12; 95% CI, 0.04-0.36; p<0.001). Conclusion: In conclusion, high density lipoprotein cholesterol was found to be an independent marker of ACS in high risk patients at our institution. Further studies on high density lipoprotein cholesterol could determine its clinical use in conjunction with troponin levels in patients presenting with ACS.

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2-OR: Impact of N Terminal Pro B-Type Natriuretic Peptide and High Sensitivity Cardiac Troponin on the Prediction of Death and Cardiovascular Events in High-Risk Patients with Type 2 Diabetes

Diabetes ◽

10.2337/db20-2-or ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 2-OR

Author(s):

MARCUS V.B. MALACHIAS ◽

PARDEEP JHUND ◽

BRIAN CLAGGETT ◽

MAGNUS O. WIJKMAN ◽

RHONDA BENTLEY-LEWIS ◽

...

Keyword(s):

Type 2 Diabetes ◽

High Risk ◽

Natriuretic Peptide ◽

Cardiac Troponin ◽

Cardiovascular Events ◽

High Sensitivity ◽

High Risk Patients ◽

Risk Patients

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Detecting high-risk patients with chest pain

Emergency Nurse ◽

10.7748/en2003.09.11.5.19.c1131 ◽

2003 ◽

Vol 11 (5) ◽

pp. 19-21 ◽

Cited By ~ 20

Author(s):

Douglas Speake ◽

Stewart Teece ◽

Kevin Mackway-Jones

Keyword(s):

Chest Pain ◽

High Risk ◽

High Risk Patients ◽

Risk Patients

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Frontal QRS-T angle as a predictive marker for myocardial damage in acute carbon monoxide poisoning

Human & Experimental Toxicology ◽

10.1177/09603271211043477 ◽

2021 ◽

pp. 096032712110434

Author(s):

Yusuf K Tekin ◽

Gülaçan Tekin ◽

Naim Nur ◽

İlhan Korkmaz ◽

Sefa Yurtbay

Keyword(s):

Carbon Monoxide ◽

Creatine Kinase ◽

Cardiac Troponin ◽

Troponin I ◽

Myocardial Damage ◽

Cardiac Troponin I ◽

Arterial Oxygen ◽

Co Poisoning ◽

Arterial Blood ◽

Creatine Kinase Mb

Introduction The present study was undertaken to investigate the prognostic value of the frontal QRS-T angle associated with adverse cardiac outcomes in patients with carbon monoxide (CO) poisoning in early stages in the emergency department. Materials and methods The data of 212 patients with CO poisoning who were admitted to the ED between January 2010 and May 2020 were retrospectively analyzed. The frontal QRS-T angle was obtained from the automatic reports of the EKG device. Results Compared to patients without myocardial damage, among patients with myocardial damage, statistically high creatinine, creatine kinase MB, cardiac troponin I, and frontal QRS-T angle values were found ( p < 0.001 for all parameters), while the saturation of arterial blood pH and arterial oxygen values were found to be lower ( p = 0.002 and p < 0.001, respectively). The frontal QRS-T angle values were correlated with creatine kinase, creatine kinase-MB, cardiac troponin I, and oxygen saturation (SpO2) in arterial blood (r = 0. 232, p = 0.001; r = 0. 253, p = < 0.001; r = 0. 389, p = < 0.001; r = −0. 198, p = 0.004, respectively). The optimum cut-off value of the frontal QRS-T angle was found to be 44.5 (area under the curve: 0.901, 95% confidence interval: 0.814–0.988, sensitivity: 87%, specificity: 84%). Conclusions The frontal QRS-T angle, a simple and inexpensive parameter that can be easily obtained from 12-lead surface electrocardiography, can be used as an early indicator in the detection of myocardial damage in patients with CO poisoning.

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Impact of Antibody Specificity and Calibration Material on the Measure of Agreement between Methods for Cardiac Troponin I

Clinical Chemistry ◽

10.1093/clinchem/45.6.822 ◽

1999 ◽

Vol 45 (6) ◽

pp. 822-828 ◽

Cited By ~ 20

Author(s):

David J Newman ◽

Yemi Olabiran ◽

William D Bedzyk ◽

Suzette Chance ◽

Eileen G Gorman ◽

...

Keyword(s):

Creatine Kinase ◽

Regression Analysis ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Antibody Specificity ◽

Serum Pool ◽

Creatine Kinase Mb ◽

Patient Values ◽

Calibration Material

Abstract Background: Available assays for cardiac troponin I (cTnI) yield numerically different results. The aim of this study was to compare patient values obtained from four cTnI immunoassays. Methods: We studied the Stratus® II assay, the Opus® II assay, the Access® assay, and a research-only cTnI heterogeneous immunoassay that uses the Dade Behring aca® plus immunoassay system equipped with two new noncommercial monoclonal antibodies. Because the aca plus cTnI assay is for research only, we first evaluated and analytically validated it for serum and citrated plasma. Initially, each method was calibrated using the method-specific calibrator supplied by each manufacturer; however, the aca plus cTnI assay was calibrated using patient serum pools containing cTnI and selected on the basis of increased creatine kinase MB isoenzyme and with values assigned by use of the Stratus cTnI assay. For method comparisons, individual patient sample cTnI values were determined and compared with the Stratus II assay. Results: Passing and Bablock regression analysis yielded slopes of 1.44 (r = 0.96; n = 72) for the Opus II vs Stratus II assays; 0.07 (r = 0.91; n = 72) for the Access vs Stratus II assays; and 0.90 (r = 0.91, n = 72) for the aca plus vs Stratus II assays. The recalibration of each method with a Stratus II-assigned serum pool improved, but did not entirely eliminate, the slope differences between the different assays (range, 1.00–1.16). The observed scatter in the correlation curves remained. Conclusion: There is a need to further explore the specificities of these assays with respect to the different circulating forms of cTnI.

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