Kinetics of high-sensitivity cardiac troponin T and I differ in patients with ST-segment elevation myocardial infarction treated by primary coronary intervention

Abstract

Purpose:

Cardiac biomarkers including troponins are the cornerstone of the biological definition of acute myocardial infarction. New high-sensitivity cardiac assays determining troponin T (hs-cTnT) as well as I ((hs-cTnI) from Abbott and s-cTnI from Siemens) raise concerns because of their unclear kinetics following the peak.

Aims:

This study aims to compare kinetics of creatine kinases, hs-cTnT, hs-cTnI and s-cTnI in patients with ST-segment elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention.

Methods:

We prospectively studied 106 consecutive patients admitted in our institution for STEMI and treated by percutaneous coronary intervention. We evaluated for all the patients simultaneously kinetics of creatine kinases, hs-cTnT (Roche) and two different cTnIs (hs-cTnI from Abbott and s-cTnI from Siemens). Modelling of kinetics was realized using mixed effects with cubic splines.

Results:

Kinetics of markers showed a first peak at 10.7h (8.0–12.0) for creatine kinases, 11.8h (10.4–13.3) for hs-cTnT (Roche); 11.8h (10.7–11.8) for hs-cTnI from Abbott and 10.2h (8.7–11.6) for s-cTnI from Siemens, respectively. This peak was followed by a nearly log linear decrease for hs-cTnI/s-cTnI and creatine kinases in contrast to hs-cTnT, which appeared with a biphasic shape curve marked by a second peak at 76.9h (69.5–82.8). The analysis of the decrease in percentage of the peak value at 77h showed that hs-cTnT follows a twice lower decrease than other markers.

Conclusion:

Kinetics of hs-cTnT, hs-cTnI and s-cTnI differ significantly with a linear decrease regarding both cTnI assays contrasting with a biphasic shape curve for hs-cTnT. This is of importance for clinical management of patients in routine settings especially in follow-up after STEMI including the suspicion of reinfarction.

Keywords

Acute myocardial infarction percutaneous coronary intervention high-sensitivity troponin creatine kinase troponin I troponin T kinetics

Get full access to this article

View all access options for this article.

References

Thygesen

Alpert

White

. Universal definition of myocardial infarction. Circulation 2007; 116: 2634–2653.

Thygesen

Alpert

Jaffe

. Third universal definition of myocardial infarction. Circulation 2012; 126: 2020–2035.

White

Thygesen

Alpert

. Clinical implications of the Third Universal Definition of Myocardial Infarction. Heart 2014; 100: 424–432.

Task Force on the management ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg

James

. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33: 2569–2619.

Thygesen

Mair

Katus

. Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J 2010; 31: 2197–2204.

Chin

Wang

. Comparison of the prognostic value of peak creatine kinase-MB and troponin levels among patients with acute myocardial infarction: A report from the Acute Coronary Treatment and Intervention Outcomes Network Registry – get with the guidelines. Clin Cardiol 2012; 35: 424–429.

Halkin

Stone

Grines

. Prognostic implications of creatine kinase elevation after primary percutaneous coronary intervention for acute myocardial infarction. J Am Coll Cardiol 2006; 47: 951–961.

Ohlmann

Monassier

Michotey

. Troponin I concentrations following primary percutaneous coronary intervention predict large infarct size and left ventricular dysfunction in patients with ST-segment elevation acute myocardial infarction. Atherosclerosis 2003; 168: 181–189.

Gravning

Smedsrud

Omland

. Sensitive troponin assays and N-terminal pro-B-type natriuretic peptide in acute coronary syndrome: Prediction of significant coronary lesions and long-term prognosis. Am Heart J 2013; 165: 716–724.

10.

Boden

Ahmed

Velders

. Peak and fixed-time high-sensitive troponin for prediction of infarct size, impaired left ventricular function, and adverse outcomes in patients with first ST-segment elevation myocardial infarction receiving percutaneous coronary intervention. Am J Cardiol 2013; 111: 1387–1393.

11.

Weber

Bazzino

Navarro Estrada

. Improved diagnostic and prognostic performance of a new high-sensitive troponin T assay in patients with acute coronary syndrome. Am Heart J 2011; 162: 81–88.

12.

Thygesen

Mair

Giannitsis

. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur Heart J 2012; 33: 2252–2257.

13.

Apple

Pearce

Smith

. Role of monitoring changes in sensitive cardiac troponin I assay results for early diagnosis of myocardial infarction and prediction of risk of adverse events. Clin Chem 2009; 55: 930–937.

14.

Reichlin

Hochholzer

Bassetti

. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 2009; 361: 858–867.

15.

Giannitsis

Kurz

Hallermayer

. Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem 2010; 56: 254–261.

16.

Solecki

Dupuy

Kuster

. Kinetics of high-sensitivity cardiac troponin T or troponin I compared to creatine kinase in patients with revascularized acute myocardial infarction. Clin Chem Lab Med 2015; 53(5): 707–714.

17.

De Luca

Ernst

Zijlstra

. Preprocedural TIMI flow and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol 2004; 43: 1363–1367.

18.

Pride

Frederick

. Association of initial thrombolysis in myocardial infarction flow grade with mortality among patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: A National Registry of Myocardial Infarction-5 (NRMI-5) analysis. Am Heart J 2011; 162: 178–183.

19.

Gibson

Murphy

Rizzo

. Relationship between TIMI frame count and clinical outcomes after thrombolytic administration. Thrombolysis In Myocardial Infarction (TIMI) Study Group. Circulation 1999; 99: 1945–1950.

20.

Stone

Cox

Garcia

. Normal flow (TIMI-3) before mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction: Analysis from the primary angioplasty in myocardial infarction trials. Circulation 2001; 104: 636–641.

21.

Koerbin

Tate

Hickman

. Analytical characteristics of the Roche highly sensitive troponin T assay and its application to a cardio-healthy population. Ann Clin Biochem 2010; 47: 524–528.

22.

Apple

Ler

Murakami

. Determination of 19 cardiac troponin I and T assay 99th percentile values from a common presumably healthy population. Clin Chem 2012; 58: 1574–1581.

23.

Apple

. A new season for cardiac troponin assays: It’s time to keep a scorecard. Clin Chem 2009; 55: 1303–1306.

24.

Levey

Stevens

Schmid

. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604-612.

25.

Mehta

Kellum

Shah

, Acute Kidney Injury Network. Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31.

26.

Guzy

. Creatine phosphokinase-MB (CPK-MB) and the diagnosis of myocardial infarction. West J Med 1977; 127: 455–460.

27.

Katus

Diederich

Schwarz

. Influence of reperfusion on serum concentrations of cytosolic creatine kinase and structural myosin light chains in acute myocardial infarction. Am J Cardiol 1987; 60: 440–445.

28.

Bertinchant

Larue

Pernel

. Release kinetics of serum cardiac troponin I in ischemic myocardial injury. Clin Biochem 1996; 29: 587–594.

29.

Nienhuis

Ottervanger

de Boer

. Zwolle Myocardial Infarction Study Group. Prognostic importance of creatine kinase and creatine kinase-MB after primary percutaneous coronary intervention for ST-elevation myocardial infarction. Am Heart J 2008; 155: 673–679.

30.

Katus

Remppis

Scheffold

. Intracellular compartmentation of cardiac troponin T and its release kinetics in patients with reperfused and nonreperfused myocardial infarction. Am J Cardiol 1991; 67: 1360–1367.

31.

Michielsen

Diris

Kleijnen

. Investigation of release and degradation of cardiac troponin T in patients with acute myocardial infarction. Clin Biochem 2007; 40: 851–855.

32.

Hessel

Michielsen

Atsma

. Release kinetics of intact and degraded troponin I and T after irreversible cell damage. Exp Mol Pathol 2008; 85: 90–95.

33.

Peivandi

Dahm

Opfermann

. Comparison of cardiac troponin I versus T and creatine kinase MB after coronary artery bypass grafting in patients with and without perioperative myocardial infarction. Herz 2004; 29: 658–664.

34.

End

Seliger

deFilippi

. Interpreting cardiac troponin results from highly sensitive assays in patients with chronic kidney disease: Acute coronary syndromes and beyond. Coron Artery Dis 2013; 24: 720–723.

35.

deFilippi

Seliger

Kelley

. Interpreting cardiac troponin results from high-sensitivity assays in chronic kidney disease without acute coronary syndrome. Clin Chem 2012; 58: 1342–1351.

36.

Sobel

Bresnahan

Shell

. Estimation of infarct size in man and its relation to prognosis. Circulation 1972; 46: 640–648.

37.

Chen

Nie

. The early diagnostic and prognostic utility of high-sensitive troponin assays in acute myocardial infarction: A meta-analysis. Intern Med J 2014. In press.

38.

Rubini Gimenez

Twerenbold

Reichlin

. Direct comparison of high-sensitivity-cardiac troponin I vs. T for the early diagnosis of acute myocardial infarction. Eur Heart J 2014; 35: 2303–2311.

39.

Gaggin

Januzzi

Jr.

Natriuretic peptides in heart failure and acute coronary syndrome. Clin Lab Med 2014; 34: 43–58, vi.

40.

Roubille

Cayla

Picot

. [C-reactive protein (CRP) after revascularized STEMI: Is CRP a prognostic factor?]. Rev Med Interne 2008; 29: 868–874.

41.

Ohlmann

Jaquemin

Morel

. Prognostic value of C-reactive protein and cardiac troponin I in primary percutaneous interventions for ST-elevation myocardial infarction. Am Heart J 2006; 152: 1161–1167.

42.

Bahrmann

Breithardt

. Additional diagnostic and prognostic value of copeptin ultra-sensitive for diagnosis of non-ST-elevation myocardial infarction in older patients presenting to the emergency department. Clin Chem Lab Med 2013; 51: 1307–1319.

43.

Damman

Beijk

Kuijt

. Multiple biomarkers at admission significantly improve the prediction of mortality in patients undergoing primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction. J Am Coll Cardiol 2011; 57: 29–36.

44.

Roubille

Micheau

Combes

. Intracoronary administration of darbepoetin-alpha at onset of reperfusion in acute myocardial infarction: Results of the randomized Intra-Co-EpoMI trial. Arch Cardiovasc Dis 2013; 106: 135–145.

45.

Roubille

Mewton

Elbaz

. No post-conditioning in the human heart with thrombolysis in myocardial infarction flow 2-3 on admission. Eur Heart J 2014; 35: 1675–1682.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.32 MB

0.12 MB