Association of Troponin-I Level on Admission with 6-month Clinical Consequences in Acute Coronary Syndrome Patients: A Preventive Approach in Patient Care

Background: Early and accurate diagnosis of acute coronary syndrome (ACS) is essential for initiating lifesaving interventions. In this article, the diagnostic performance of a novel point-of-care rapid assay (SensAheart©) is analyzed. This assay qualitatively determines the presence of 2 cardiac biomarkers troponin I and heart-type fatty acid-binding protein that are present soon after onset of myocardial injury. Methods: We conducted a prospective observational study of consecutive patients who presented to the emergency department with typical chest pain. Simultaneous high-sensitive cardiac troponin T (hs-cTnT) and SensAheart testing was performed upon hospital admission. Diagnostic accuracy was computed using SensAheart or hs-cTnT levels versus the final diagnosis defined as positive/negative. Results: Of 225 patients analyzed, a final diagnosis of ACS was established in 138 patients, 87 individuals diagnosed with nonischemic chest pain. In the overall population, as compared to hs-cTnT, the sensitivity of the initial SensAheart assay was significantly higher (80.4 vs. 63.8%, p = 0.002) whereas specificity was lower (78.6 vs. 95.4%, p = 0.036). The overall diagnostic accuracy of SensAheart assay was similar to the hs-cTnT (82.7% compared to 76.0%, p = 0.08). Conclusions: Upon first medical contact, the novel point-of-care rapid SensAheart assay shows a diagnostic performance similar to hs-cTnT. The combination of 2 cardiac biomarkers in the same kit allows for very early detection of myocardial damage. The SensAheart assay is a reliable and practical tool for ruling-in the diagnosis of ACS.

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Diagnostic potential of phosphorylated cardiac troponin I as a sensitive, cardiac-specific marker for early acute coronary syndrome: Preliminary report

Clinica Chimica Acta ◽

10.1016/j.cccn.2005.05.015 ◽

2005 ◽

Vol 362 (1-2) ◽

pp. 65-70 ◽

Cited By ~ 4

Author(s):

David Bar-Or ◽

Gregory W. Thomas ◽

Raphael Bar-Or ◽

Leonard Rael ◽

James V. Winkler

Keyword(s):

Acute Coronary Syndrome ◽

Cardiac Troponin ◽

Preliminary Report ◽

Troponin I ◽

Cardiac Troponin I ◽

Specific Marker ◽

Coronary Syndrome ◽

Diagnostic Potential

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Predictive Value of Endocan Based on TIMI Risk Score on Major Adverse Cardiovascular Events After Acute Coronary Syndrome

Angiology ◽

10.1177/0003319718815241 ◽

2018 ◽

Vol 70 (10) ◽

pp. 952-959 ◽

Cited By ~ 3

Author(s):

Mojtaba Ziaee ◽

Sina Mashayekhi ◽

Samad Ghaffari ◽

Javad Mahmoudi ◽

Parvin Sarbakhsh ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Risk Score ◽

Troponin I ◽

Multivariate Logistic Regression Analysis ◽

Major Adverse Cardiovascular Events ◽

Hospital Death ◽

Coronary Syndrome ◽

Creatine Kinase Mb ◽

Timi Risk Score

We assessed the prognostic value of serum levels of endocan in patients with the acute coronary syndrome (ACS) through its correlation with the Thrombolysis in Myocardial Infarction (TIMI) risk score and compared the possible association with clinical outcomes. In this prospective cross-sectional study, we enrolled 320 patients with documented ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), or unstable angina (UA) who underwent diagnostic coronary angiography. Endocan was measured soon after admission in the emergency department. In-hospital death, heart failure, and recurrent infarction were considered major adverse cardiac events (MACEs). There was a significant positive correlation between endocan level and TIMI risk score and MACE. The optimal cutoff values of endocan to predict clinical end points were 3.45 ng/mL in patients with STEMI and 2.85 ng/mL in patients with UA/NSTEMI. Multivariate logistic regression analysis indicated that endocan independently correlated with MACE. Moreover, cardiac troponin I, creatine kinase-MB, and circulating endocan were found to be independently associated with MACE in patients with ACS. In conclusion, a high endocan level on hospital admission is an independent predictor of worse cardiovascular outcomes and higher TIMI risk score in patients with ACS.

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Value of Cardiac Troponin I Cutoff Concentrations below the 99th Percentile for Clinical Decision-Making

Clinical Chemistry ◽

10.1373/clinchem.2007.101683 ◽

2009 ◽

Vol 55 (1) ◽

pp. 85-92 ◽

Cited By ~ 94

Author(s):

Kai M Eggers ◽

Allan S Jaffe ◽

Lars Lind ◽

Per Venge ◽

Bertil Lindahl

Keyword(s):

Coronary Artery Disease ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Risk Stratification ◽

Cardiac Troponin ◽

Troponin I ◽

Reference Population ◽

Cardiac Troponin I ◽

Coronary Syndrome ◽

Artery Disease

Abstract Background: The aim of this study was to evaluate factors influencing the 99th percentile for cardiac troponin I (cTnI) when this cutoff value is established on a highly sensitive assay, and to compare the value of this cutoff to that of lower cutoffs in the prognostic assessment of patients with coronary artery disease. Methods: We used the recently refined Access AccuTnI assay (Beckman-Coulter) to assess the distribution of cTnI results in a community population of elderly individuals [PIVUS (Prospective Study of the Vasculature in Uppsala Seniors) study; n = 1005]. The utility of predefined cTnI cutoffs for risk stratification was then evaluated in 952 patients from the FRISC II (FRagmin and Fast Revascularization during InStability in Coronary artery disease) study at 6 months after these patients had suffered acute coronary syndrome. Results: Selection of assay results from a subcohort of PIVUS participants without cardiovascular disease resulted in a decrease of the 99th percentile from 0.044 μg/L to 0.028 μg/L. Men had higher rates of cTnI elevation with respect to the tested thresholds. Whereas the 99th percentile cutoff was not found to be a useful prognostic indicator for 5-year mortality, both the 90th percentile (hazard ratio 3.1; 95% CI 1.9–5.1) and the 75th percentile (hazard ratio 2.8; 95% CI 1.7–4.7) provided useful prognostic information. Sex-specific cutoffs did not improve risk prediction. Conclusions: The 99th percentile of cTnI depends highly on the characteristics of the reference population from which it is determined. This dependence on the reference population may affect the appropriateness of clinical conclusions based on this threshold. However, cTnI cutoffs below the 99th percentile seem to provide better prognostic discrimination in stabilized acute coronary syndrome patients and therefore may be preferable for risk stratification.

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Impact of high‐sensitivity cardiac troponin I assays on patients presenting to an emergency department with suspected acute coronary syndrome

The Medical Journal of Australia ◽

10.5694/mja13.00117 ◽

2014 ◽

Vol 201 (3) ◽

pp. 158-161 ◽

Cited By ~ 10

Author(s):

Thomas P Y Yip ◽

Heather M Pascoe ◽

Stephen E Lane

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Cardiac Troponin ◽

Troponin I ◽

High Sensitivity ◽

Cardiac Troponin I ◽

Coronary Syndrome

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Prognostic Value of Troponin I with Echocardiography Assessment in Septic Patients

QJM ◽

10.1093/qjmed/hcab086.001 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Sherif Farouk Ibrahim ◽

Ashraf Elsayed Elagmy ◽

Abdelrhman Gamal Abdelsabour

Keyword(s):

Septic Shock ◽

Acute Coronary Syndrome ◽

Intensive Care ◽

Cardiac Troponin ◽

Prognostic Value ◽

Troponin I ◽

Cardiac Troponin I ◽

Coronary Syndrome ◽

Sepsis And Septic Shock

Abstract Background Sepsis is heterogenous with regard to factors such as causal microorganism, patient predisposition, co-morbidity and response to therapy, a key element and unifying feature is the manifestation of cardiovascular dysfunction. Elevated concentrations of cardiac troponin I (cTnI) are frequently observed in patients with severe sepsis and septic shock even in the absence of an acute coronary syndrome (ACS). Objective To evaluate the prognostic value of (cTnI) with echocardiography assessment in septic patients. Patients and Methods This study was conducted at the intensive care units of Ain Shams university hospitals. 20 patients of both sexes with age ranging from 18 to 70 years diagnosed with sepsis admitted to Intensive care unit were included in prospective observational study. Results Baseline cTnI had a significant positive correlation with follow up troponine (p = 0.0016). Baseline EF had a significant negative correlation with follow up troponine (p = 0.036). Using ROC-curve analysis, troponin level at a cutoff point (>1.9) predicted patients with mortality, with good (87%) accuracy, sensitivity= 90% and specificity= 90% (p < 0.01). Conclusion Elevated concentrations of cardiac troponin I (cTnI) are frequently observed in patients with sepsis and septic shock even in the absence of an acute coronary syndrome.

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Takotsubo syndrome in elderly woman: The diagnosis by transthoracic echocardiography

SAGE Open Medical Case Reports ◽

10.1177/2050313x19878928 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1987892

Author(s):

Inggita Hanung Sulistya ◽

Anggoro Budi Hartopo ◽

Lucia Kris Dinarti ◽

Budi Yuli Setianto

Keyword(s):

Acute Coronary Syndrome ◽

Left Ventricle ◽

Transthoracic Echocardiography ◽

Troponin I ◽

Acute Chest Pain ◽

Apical Ballooning ◽

Transient Condition ◽

Takotsubo Syndrome ◽

Coronary Syndrome ◽

Concentric Hypertrophy

Takotsubo syndrome has increasingly been recognized in the differential diagnosis of patients presenting with acute chest pain. Those affected are typically older women suffering after an emotional or physical stress. Normally it is a transient condition but complications including death have been reported. We reported a case of takotsubo syndrome who was initially diagnosed as acute coronary syndrome. The patient presented with typical angina, ST-T segment changes, and elevated high sensitive–troponin I. Coronary angiography showed normal coronary arteries. Transthoracic echocardiography revealed mild left atrial dilatation and left ventricle concentric hypertrophy, reduced left ventricle ejection fraction with circumferential hypokinetic, apical ballooning, systolic anterior motion, left ventricle outflow tract obstruction, and sigmoid septum hypertrophy. One month later, patient recovered and transthoracic echocardiography revealed improved heart anatomy and function. To differentiate takotsubo syndrome with other conditions, especially acute coronary syndrome, is crucial. Their clinical presentations are similar but the managements are different. The transthoracic echocardiography holds an important role in supporting the diagnosis of takotsubo syndrome.

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