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Enzymes and Protein Markers |
1
Department of Pathology, University of Maryland School of Medicine, Baltimore, MD.
2
Duke Clinical Research Institute, Durham, NC.
3
Department of Medicine, University of Edmonton,
Edmonton, AB, Canada.
4
Medizinische Klinik II, Medizinische
Universität Lübeck, Lübeck, Germany.
5
The Cleveland Clinic Foundation, Cleveland, OH.
a Address correspondence to this author at: Clinical Pathology, University of Maryland Medical Center, 22 South Greene St., Baltimore, MD 21201. Fax 410-328-5880; e-mail rchriste{at}umms001.ab.umd.edu.
We compared cardiac troponins T (cTnT) and I (cTnI) collected
within 3.5 h of ischemic symptoms for predicting clinical outcomes
in 770 patients. cTnT (cutoff >0.1 µg/L) and cTnI (cutoff >1.5
µg/L) were concordant (both positive or negative) in 90.4% of
patients. Among discordant results, 66 were cTnT positive and cTnI
negative vs 8 who showed the reverse (P <0.001). Five
cTnT-positive and cTnI-negative patients died within 30 days; none who
were cTnT negative and cTnI positive died. cTnT showed a slightly
greater association (
2 = 18.0, P
<0.001) with 30-day mortality than cTnI (2 =
12.5, P = 0.002). The area of the ROC curve for
predicting 30-day mortality was significantly larger
(Z = 2.08; P = 0.0375) for cTnT, at
0.68 [95% confidence interval (CI) 0.60–0.75], compared with cTnI,
at 0.64 (95% CI 0.56–0.72). When cTnI and the electrocardiogram (ECG)
were put in a logistic multiple regression model, cTnT added
significant information (2 = 8.03,
P = 0.045); however, cTnI did not add to a model
containing cTnT and the ECG (2 = 0.84,
P = 0.657). cTnT provided more information than cTnI
for predicting 30-day mortality early after presentation with acute
coronary syndromes.
The following articles in journals at HighWire Press have cited this article:
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  R. Shah, J. Selter, Y. Wang, M. Greenspan, and J. M. Foody Association of Troponin Status With Guideline-Based Management of Acute Myocardial Infarction in Older Persons Arch Intern Med, August 13, 2007; 167(15): 1621 - 1628. [Abstract] [Full Text] [PDF]
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 P. Kupchak, A. H.B. Wu, F. Ghani, L. K. Newby, E. M. Ohman, and R. H. Christenson Influence of Imprecision on ROC Curve Analysis for Cardiac Markers Clin. Chem., April 1, 2006; 52(4): 752 - 753. [Abstract] [Full Text] [PDF]
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 L. Babuin and A. S. Jaffe Troponin: the biomarker of choice for the detection of cardiac injury Can. Med. Assoc. J., November 8, 2005; 173(10): 1191 - 1202. [Abstract] [Full Text] [PDF]
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 J. F. Keaney Jr Circulating Biomarkers in Acute Coronary Syndromes: Something Different or More of the Same? Circulation, August 9, 2005; 112(6): 778 - 780. [Full Text] [PDF]
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R. Rej Clinical Chemistry through Clinical Chemistry: A Journal Timeline Clin. Chem., December 1, 2004; 50(12): 2415 - 2458. [Abstract] [Full Text] [PDF]
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D. Ritter, P. A. Lee, J. F. Taylor, L. Hsu, J. D. Cohen, H. D. Chung, and K. S. Virgo Troponin I in Patients without Chest Pain Clin. Chem., January 1, 2004; 50(1): 112 - 119. [Abstract] [Full Text] [PDF]
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 G. N. I. Wood, B. Keevil, J. Gupta, R. Foley, A. Bubtana, G. McDowell, and P. Ackrill Serum troponin T measurement in patients with chronic renal impairment predicts survival and vascular disease: a 2 year prospective study Nephrol. Dial. Transplant., August 1, 2003; 18(8): 1610 - 1615. [Abstract] [Full Text] [PDF]
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G. N. I. Wood, B. Keevil, J. Gupta, R. Foley, A. Bubtana, G. McDowell, and P. Ackrill Serum troponin T measurement in patients with chronic renal impairment predicts survival and vascular disease: a 2 year prospective study Nephrol. Dial. Transplant., August 1, 2003; 18(88): 1610 - 1615. [Abstract] [Full Text]
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L. J. Kim, E. A. Martinez, N. Faraday, T. Dorman, L. A. Fleisher, B. A. Perler, G. M. Williams, D. Chan, and P. J. Pronovost Cardiac Troponin I Predicts Short-Term Mortality in Vascular Surgery Patients Circulation, October 29, 2002; 106(18): 2366 - 2371. [Abstract] [Full Text] [PDF]
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D. Peetz, G. Hafner, and K. J. Lackner Analytical Characteristics of the AxSYM Cardiac Troponin I and Creatine Kinase MB Assays Clin. Chem., July 1, 2002; 48(7): 1110 - 1111. [Full Text] [PDF]
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 T. M. Welsh, G. D. Kukes, and L. M. Sandweiss Differences of Creatine Kinase MB and Cardiac Troponin I Concentrations in Normal and Diseased Human Myocardium Ann. Clin. Lab. Sci., January 1, 2002; 32(1): 44 - 49. [Abstract] [Full Text] [PDF]
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 P. A. Heidenreich, T. Alloggiamento, K. Melsop, K. M. McDonald, A. S. Go, and M. A. Hlatky The prognostic value of troponin in patients with non-ST elevation acute coronary syndromes: a meta-analysis J. Am. Coll. Cardiol., August 1, 2001; 38(2): 478 - 485. [Abstract] [Full Text] [PDF]
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S. Fredericks, J. F. Murray, M. Bewick, R. Chang, P. O. Collinson, N. D. Carter, and D. W. Holt Cardiac Troponin T and Creatine Kinase MB Are Not Increased in Exterior Oblique Muscle of Patients with Renal Failure Clin. Chem., June 1, 2001; 47(6): 1023 - 1030. [Abstract] [Full Text] [PDF]
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D. S. Ooi, D. Zimmerman, J. Graham, and G. A. Wells Cardiac Troponin T Predicts Long-Term Outcomes in Hemodialysis Patients Clin. Chem., March 1, 2001; 47(3): 412 - 417. [Abstract] [Full Text] [PDF]
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T. Schluter, H. Baum, A. Plewan, and D. Neumeier Effects of Implantable Cardioverter Defibrillator Implantation and Shock Application on Biochemical Markers of Myocardial Damage Clin. Chem., March 1, 2001; 47(3): 459 - 463. [Abstract] [Full Text] [PDF]
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D. A. Morrow, E. M. Antman, M. Tanasijevic, N. Rifai, J. A. de Lemos, C. H. McCabe, C. P. Cannon, and E. Braunwald Cardiac troponin I for stratification of early outcomes and the efficacy of enoxaparin in unstable angina: a TIMI-11B substudy J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1812 - 1817. [Abstract] [Full Text] [PDF]
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S. Matetzky, T. Sharir, M. Domingo, M. Noc, K.-Y. Chyu, S. Kaul, N. Eigler, P. K. Shah, and B. Cercek Elevated Troponin I Level on Admission Is Associated With Adverse Outcome of Primary Angioplasty in Acute Myocardial Infarction Circulation, October 3, 2000; 102(14): 1611 - 1616. [Abstract] [Full Text] [PDF]
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E. Braunwald, E. M. Antman, J. W. Beasley, R. M. Califf, M. D. Cheitlin, J. S. Hochman, R. H. Jones, D. Kereiakes, J. Kupersmith, T. N. Levin, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment elevation myocardial infarction: A report of the american college of cardiology/ american heart association task force on practice guidelines (committee on the management of patients with unstable angina) J. Am. Coll. Cardiol., September 1, 2000; 36(3): 970 - 1062. [Full Text] [PDF]
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J. Ash, G. Baxevanakis, L. Bilandzic, H. Shin, and L. Kadijevic Development of an Automated Quantitative Latex Immunoassay for Cardiac Troponin I in Serum, Clin. Chem., September 1, 2000; 46(9): 1521 - 1522. [Full Text] [PDF]
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 P James, C J Ellis, R M L Whitlock, A R McNeil, J Henley, and N E Anderson Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study BMJ, June 3, 2000; 320(7248): 1502 - 1504. [Abstract] [Full Text]
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K. M. ver Elst, H. D. Spapen, D. N. Nguyen, C. Garbar, L. P. Huyghens, and F. K. Gorus Cardiac Troponins I and T Are Biological Markers of Left Ventricular Dysfunction in Septic Shock Clin. Chem., May 1, 2000; 46(5): 650 - 657. [Abstract] [Full Text] [PDF]
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D. A. Morrow, N. Rifai, M. J. Tanasijevic, D. R. Wybenga, J. A. de Lemos, and E. M. Antman Clinical Efficacy of Three Assays for Cardiac Troponin I for Risk Stratification in Acute Coronary Syndromes: A Thrombolysis In Myocardial Infarction (TIMI) 11B Substudy Clin. Chem., April 1, 2000; 46(4): 453 - 460. [Abstract] [Full Text] [PDF]
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 S J MAYNARD, I B A MENOWN, and A A J ADGEY Troponin T or troponin I as cardiac markers in ischaemic heart disease Heart, April 1, 2000; 83(4): 371 - 373. [Full Text]
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 M Lund, J.K French, R.N Johnson, B.F Williams, and H.D White Serum troponins T and I after elective cardioversion Eur. Heart J., February 1, 2000; 21(3): 245 - 253. [Abstract] [PDF]
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L. P. Roppolo, R. Fitzgerald, J. Dillow, T. Ziegler, M. Rice, and A. Maisel A comparison of troponin T and troponin I as predictors of cardiac events in patients undergoing chronic dialysis at a Veteran's Hospital: a pilot study J. Am. Coll. Cardiol., August 1, 1999; 34(2): 448 - 454. [Abstract] [Full Text] [PDF]
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J. C. Stolear, B. Georges, A. Shita, and D. Verbeelen The predictive value of cardiac troponin T measurements in subjects on regular haemodialysis Nephrol. Dial. Transplant., August 1, 1999; 14(8): 1961 - 1967. [Abstract] [Full Text] [PDF]
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F. S. Apple, A. J. Maturen, R. E. Mullins, P. C. Painter, M. S. Pessin-Minsley, R. A. Webster, J. Spray Flores, R. DeCresce, D. J. Fink, P. M. Buckley, et al. Multicenter Clinical and Analytical Evaluation of the AxSYM Troponin-I Immunoassay to Assist in the Diagnosis of Myocardial Infarction Clin. Chem., February 1, 1999; 45(2): 206 - 212. [Abstract] [Full Text] [PDF]
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F. S. Apple Clinical and Analytical Standardization Issues Confronting Cardiac Troponin I Clin. Chem., January 1, 1999; 45(1): 18 - 20. [Full Text] [PDF]
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B. Bluestein, G. Parsons, and K. Foster Increased Concentrations of Cardiac Troponin I Are Equivalent to Increased Cardiac Troponin T in Identifying Chest Pain Patients at Short-Term Risk of Myocardial Infarction Clin. Chem., August 1, 1998; 44(8): 1785 - 1786. [Full Text] [PDF]
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F. S. Apple Another reader comments on the same article: Clin. Chem., August 1, 1998; 44(8): 1786 - 1787. [Full Text]
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R. H. Christenson and H. M. E. Azzazy Biochemical markers of the acute coronary syndromes Clin. Chem., August 1, 1998; 44(8): 1855 - 1864. [Abstract] [Full Text] [PDF]
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