Role of serum cardiac Troponin-I for risk stratification in first attack in acute myocardial infarction

Introduction: Cardiac troponin-I (cTnI) is known to have the highest specificity and analytic sensitivity for detection of myocardial injury; it is used both as diagnostic and prognostic marker. This study was aimed to confirm this idea. Subjects & methods: This prospective observational study included 60 patients of 40 to 65 years age range diagnosed as acute myocardial infarction. The mean ages were 50±8 years and 53±8 years in Q -wave AMI and non Q-wave AMI respectively. Male and female patients included were 86.7% and 13.3%; BMI was 25.3±1.5. Results: Study showed troponin-I 7.53±0.086 ng/ml in Q wave and in non Q-wave AMI was 6.38±0.64 ng/ml after 24 hours of attack of AMI without any significant difference between two groups (P>0.05). The mean troponin-I within 9 hours of attack, were 1.60±0.80 ng/ml and 2.7±1.4 ng/ml in stable and unstable group respectively and the difference found statistically significant (P<0.05). The mean troponin-I between 9-24 hours of attack were 2.90±1.20 ng/ml and 4.90±3.20 ng/ml in stable and unstable group respectively and the difference found statistically significant (P<0.01). The mean troponin-I in unstable group after 24 hours was 9.20±4.30 ng/ml which was more than between 9-24 hours and the difference was significant (P>0.001). In clinicopathological outcome evaluation 37 patients had troponin-I level >1.5 ng/ml in which 29 patients developed unstability and 8 patients were stable. Conclusion: Serum cTnI is better and more characteristic biomarker for risk prediction and prognosis evaluation in AMI patients. Key words: Cardiac Troponin-I, acute myocardial infarction, risk stratification. DOI: 10.3329/bjms.v8i3.3984 Bangladesh Journal of Medical Sciences Vol.8(3) 2009 p57-63

Download Full-text

Cardiac Troponin-I And CK-MB for Risk Stratification in Acute Myocardial Infarction (First Attack): A Comparative Study

Bangladesh Journal of Medical Biochemistry ◽

10.3329/bjmb.v4i1.13776 ◽

2013 ◽

Vol 4 (1) ◽

pp. 10-15 ◽

Cited By ~ 1

Author(s):

S Joarder ◽

M Hoque ◽

M Towhiduzzaman ◽

AF Salehuddin ◽

N Islam ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

High Risk ◽

Cardiac Troponin ◽

Troponin I ◽

Risk Group ◽

Risk Groups ◽

Low Risk ◽

The Mean ◽

The Difference

Myocardial infarction is associated with release of two important enzymes. The enzymatic diagnosis is mainly based on the measurement of CK-MB and troponin-I. Cardiac troponin- I(cTnI) is known to have higher specificity and analytic sensitivity than CK-MB for detection of myocardial injury & risk stratification. These are used both as diagnostic and prognostic marker. This prospective observational study included 60 patients of 40-65 years age range, diagnosed as acute myocardial infarction. The mean ages were 50± 8 years and 53±8 years respectively. Male and female patients included were 86.7% and 13.3%; BMI was 25.3±1.5. The two important cardiac markers troponin-I and CK-MB were studied in 60 patients, admitted in the hospital with acute MI. Blood samples to estimate these markers were collected from the patients after admission at 6-9 hours, 9-24 hours and after 24 hours and their mean values with ±SD were calculated, evaluated and compared between the two groups of patients with low and high risk MI. The patients with low risk MI were those who recovered early and the high risk patients improved later in comparison to low risk group. Out of 60 patients, 37 had troponin-I level>1.5 ng /ml. Among them 29 developed high risk MI and 8 recovered earlier than high risk group. 23 patients had troponin-I <1.5 ng /ml, out of whom 10 were high and 13 were low risk. The difference of troponin-I levels between high and low risk groups of patients was statistically significant (p<0.01). On the other hand CK-MB level was >7 ng /ml in 33 patients. Out of them 22 patients developed high and 11 patients were low risk but 18 patients out of 27 who had CK-MB <7 ng /ml became high and 9 patients were low risk. The difference of outcome in respect to higher and lower values of CK-MB between the two groups was not statistically significant (p>0.05). Both troponin-I and CK-MB were estimated in all 60 patients on three occasions. The mean troponin-I levels were statistically significant between the high and the low risk groups on all occasions. On the contrary, the values of CK-MB were not statistically significant on two occasions but was significant (p < 0.01) on one occasion when it was estimated at 9 - 24 hour. Serum cTnI is better and more characteristic biomarker than CK-MB for risk prediction and prognosis evaluation in AMI patients. DOI: http://dx.doi.org/10.3329/bjmb.v4i1.13776 Bangladesh J Med Biochem 2011; 4(1): 10-15

Download Full-text

Faculty Opinions recommendation of One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725420089.793507697 ◽

2015 ◽

Author(s):

Patrick Ray

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Troponin ◽

Troponin I ◽

High Sensitivity ◽

Cardiac Troponin I ◽

Rule Out

Download Full-text

Abstract 2425: Absence of Auto-Antibodies against Cardiac Troponin I Predicts Improvement of Left Ventricular Function after Acute Myocardial Infarction

Circulation ◽

10.1161/circ.118.suppl_18.s_724-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Florian Leuschner ◽

Jin Li ◽

Stefan Göser ◽

Lars Reinhardt ◽

Renate Öttl ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Stroke Volume ◽

Antibody Titer ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Igg Antibody ◽

Follow Up Study

Application of antibodies against cardiac troponin I (cTnI-Ab) can induce dilation and dysfunction of the heart in mice. Recently, we demonstrated that immunization with cTnI induces inflammation and fibrosis in myocardium of mice. Others have shown that autoanti-bodies to cTnI are present in patients with acute coronary syndrome. But little is known about the clinical relevance of detected cTnI-Ab. First, anti-cTnI and anti-cTnT antibody titers were measured in sera from 272 patients with dilated- (DCM) and 185 with ischemic- (ICM) cardiomyopathy. Secondly, 108 patients with acute myocardial infarction (AMI) were included for a follow-up study. Heart characteristics were determined by magnetic resonance imaging 4 days and 6 –9 months after AMI. Altogether, in 7,0% of patients with DCM and in 9,2% with ICM an anti-cTnI IgG antibody titer ≥1:160 was measured. In contrast, only in 1,7% of patients with DCM and in 0,5% with ICM an anti-cTnT IgG antibody titer ≥1:160 was detected. Ten out of 108 patients included in the follow-up study were tested positive for cTnI-Ab with IgG Ab titers ≥1:160. TnI-Ab negative patients showed a significant increase in LVEF and stroke volume 6 –9 months after AMI. In contrast, there was no significant increase in LVEF and stroke volume in TnI-Ab positive patients. We demonstrate for the first time that the prevalence of cTnI-Abs in patients with AMI has an impact on the improvement of the LVEF over a study period of 6 –9 months.

Download Full-text

Acceptable Analytical Variation May Exceed High-Sensitivity Cardiac Troponin I Cutoffs in Early Rule-Out and Rule-In Acute Myocardial Infarction Algorithms

Clinical Chemistry ◽

10.1373/clinchem.2016.255448 ◽

2016 ◽

Vol 62 (6) ◽

pp. 887-889 ◽

Cited By ~ 36

Author(s):

Peter A Kavsak ◽

Andrew C Don-Wauchope ◽

Stephen A Hill ◽

Andrew Worster

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Troponin ◽

Troponin I ◽

High Sensitivity ◽

Cardiac Troponin I ◽

Analytical Variation ◽

Rule Out

Download Full-text

Comparable detection of acute myocardial infarction by creatine kinase MB isoenzyme and cardiac troponin I

Clinical Chemistry ◽

10.1093/clinchem/40.7.1291 ◽

1994 ◽

Vol 40 (7) ◽

pp. 1291-1295 ◽

Cited By ~ 197

Author(s):

J E Adams ◽

K B Schechtman ◽

Y Landt ◽

J H Ladenson ◽

A S Jaffe

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Creatine Kinase ◽

Cardiac Troponin ◽

Troponin I ◽

Characteristic Curve ◽

Cardiac Injury ◽

Cardiac Troponin I ◽

Creatine Kinase Mb ◽

Coronary Care

Abstract Although measurement of cardiac troponin I (cTnI) is, in some situations, more specific for detection of cardiac injury than is measurement of the MB isoenzyme of creatine kinase (MBCK), its sensitivity and specificity relative to MBCK for detection of myocardial infarction has not been established. Accordingly, we studied prospectively 199 consecutive patients admitted to the coronary care unit. Values of MBCK and cTnI mass were determined in all samples. Of the 188 patients admitted with a suspicion of acute myocardial ischemia, 89 were diagnosed as having an acute myocardial infarction on the basis of the patterns of MBCK values. Eighty-six of these patients also had increased cTnI (concordance, 96.6%); three did not. Of the patients diagnosed as without infarction, five with unstable angina and symptoms in the day(s) prior to admission had increased cTnI, for a cTnI specificity of 94.9%. Receiver operating characteristic curve analysis indicated that cTnI and MBCK had statistically indistinguishable diagnostic accuracies for the detection of acute myocardial infarction.

Download Full-text