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1
Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115.
2
Department of Laboratory Medicine, Children’s Hospital,
Boston, MA 02115.
3
Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115.
a Address correspondence to this author at: Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115. Fax 617-975-0990; e-mail damorrow{at}bics.bwh.harvard.edu
Background: Significant analytic variability exists between the multiple assays for cardiac troponin I (cTnI) approved for clinical use. Until adequate cTnI standardization is possible, an evidence-based approach evaluating each assay at specific thresholds appears warranted.
Methods: We examined the efficacy of three cTnI assays for predicting death, myocardial infarction (MI), or the composite of death, MI, or urgent revascularization at 43 days among patients with non-ST-elevation acute coronary syndromes enrolled in the Thrombolysis In Myocardial Infarction (TIMI) 11B study.
Results: Six hundred eighty-one patients with serum samples
obtained at baseline and/or 12–24 h had cTnI determined using all
three assays. Baseline cTnI was 
0.1 µg/L for 368, 395, and 418
patients with the Bayer Immuno 1TM, ACS:180®,
and Dimension® RxL assays, respectively. Correlation
coefficients for the RxL with the ACS:180 and Bayer Immuno 1 results
were 0.89 (P = 0.0001) and 0.87
(P = 0.0001), with a coefficient of 0.92
(P = 0.0001) for the ACS:180 and Bayer Immuno 1
assays. Patients with cTnI 0.1 µg/L were at increased risk for
death or MI by 43 days (relative risk, 2.2–3.0; P
<0.0006), regardless of the assay used. This prognostic capacity
persisted among those with creatine kinase MB isoenzyme concentrations
within the reference interval. Moreover, cTnI was the strongest
multivariate predictor of death, MI, or urgent revascularization with
adjusted odds ratios of 2.1–2.9 (P <0.0006).
Conclusion: This study demonstrates the prognostic efficacy of three independently developed cTnI assays at a threshold of 0.1 µg/L for the prediction of adverse clinical outcomes among patients with non-ST-elevation acute coronary syndromes.
The following articles in journals at HighWire Press have cited this article:
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  P. O Collinson, G. H Gaynor, and D. C Gaze Cardiac troponin I measurement using the ACS:180 to predict four-year cardiac event rate Ann Clin Biochem, March 1, 2008; 45(2): 184 - 188. [Abstract] [Full Text] [PDF]
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 B. M. Scirica, D. A. Morrow, C. P. Cannon, J. A. de Lemos, S. Murphy, M. S. Sabatine, S. D. Wiviott, N. Rifai, C. H. McCabe, E. Braunwald, et al. Clinical Application of C-Reactive Protein Across the Spectrum of Acute Coronary Syndromes Clin. Chem., October 1, 2007; 53(10): 1800 - 1807. [Abstract] [Full Text] [PDF]
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 NACB WRITING GROUP MEMBERS, D. A. Morrow, C. P. Cannon, R. L. Jesse, L. K. Newby, J. Ravkilde, A. B. Storrow, A. H.B. Wu, and R. H. Christenson National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes Circulation, April 3, 2007; 115(13): e356 - e375. [Full Text] [PDF]
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NACB WRITING GROUP MEMBERS, D. A. Morrow, C. P. Cannon, R. L. Jesse, L. K. Newby, J. Ravkilde, A. B. Storrow, A. H.B. Wu, R. H. Christenson, NACB COMMITTEE MEMBERS, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes Clin. Chem., April 1, 2007; 53(4): 552 - 574. [Full Text] [PDF]
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 D. Abramov, M. Abu-Tailakh, M. Frieger, A. Ganiel, D. Tuvbin, and A. Wolak Plasma Troponin Levels After Cardiac Surgery vs After Myocardial Infarction Asian Cardiovasc Thorac Ann, December 1, 2006; 14(6): 530 - 535. [Abstract] [Full Text] [PDF]
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M. O'Donoghue, J. A. de Lemos, D. A. Morrow, S. A. Murphy, J. L. Buros, C. P. Cannon, and M. S. Sabatine Prognostic Utility of Heart-Type Fatty Acid Binding Protein in Patients With Acute Coronary Syndromes Circulation, August 8, 2006; 114(6): 550 - 557. [Abstract] [Full Text] [PDF]
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 A. Hays and M. N. Diringer Elevated troponin levels are associated with higher mortality following intracerebral hemorrhage Neurology, May 9, 2006; 66(9): 1330 - 1334. [Abstract] [Full Text] [PDF]
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F. S. Apple, C. A. Parvin, K. F. Buechler, R. H. Christenson, A. H.B. Wu, and A. S. Jaffe Validation of the 99th Percentile Cutoff Independent of Assay Imprecision (CV) for Cardiac Troponin Monitoring for Ruling Out Myocardial Infarction Clin. Chem., November 1, 2005; 51(11): 2198 - 2200. [Full Text] [PDF]
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 H. Dokainish, M. Pillai, S. A. Murphy, P. M. DiBattiste, M. J. Schweiger, A. Lotfi, D. A. Morrow, C. P. Cannon, E. Braunwald, N. Lakkis, et al. Prognostic implications of elevated troponin in patients with suspected acute coronary syndrome but no critical epicardial coronary disease: A TACTICS-TIMI-18 substudy J. Am. Coll. Cardiol., January 4, 2005; 45(1): 19 - 24. [Abstract] [Full Text] [PDF]
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 E Di Angelantonio, M Fiorelli, D Toni, M L Sacchetti, S Lorenzano, A Falcou, M V Ciarla, M Suppa, L Bonanni, G Bertazzoni, et al. Prognostic significance of admission levels of troponin I in patients with acute ischaemic stroke J. Neurol. Neurosurg. Psychiatry, January 1, 2005; 76(1): 76 - 81. [Abstract] [Full Text] [PDF]
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K. Araujo, J. da Silva, A. Sanudo, and B. Kopelman Plasma Concentrations of Cardiac Troponin I in Newborn Infants Clin. Chem., September 1, 2004; 50(9): 1717 - 1718. [Full Text] [PDF]
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J. L. Mega, D. A. Morrow, J. A. de Lemos, M. S. Sabatine, S. A. Murphy, N. Rifai, C. M. Gibson, E. M. Antman, and E. Braunwald B-type natriuretic peptide at presentation and prognosis in patients with ST-segment elevation myocardial infarction: An ENTIRE-TIMI-23 substudy J. Am. Coll. Cardiol., July 21, 2004; 44(2): 335 - 339. [Abstract] [Full Text] [PDF]
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 K A A Fox, J Birkhead, R Wilcox, C Knight, and J Barth British Cardiac Society Working Group on the definition of myocardial infarction Heart, June 1, 2004; 90(6): 603 - 609. [Abstract] [Full Text] [PDF]
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M. Shimpo, D. A. Morrow, E. O. Weinberg, M. S. Sabatine, S. A. Murphy, E. M. Antman, and R. T. Lee Serum Levels of the Interleukin-1 Receptor Family Member ST2 Predict Mortality and Clinical Outcome in Acute Myocardial Infarction Circulation, May 11, 2004; 109(18): 2186 - 2190. [Abstract] [Full Text] [PDF]
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M. C. Kontos, R. Shah, L. M. Fritz, F. P. Anderson, J. L. Tatum, J. P. Ornato, and R. L. Jesse Implication of different cardiac troponin I levels for clinical outcomes and prognosis of acute chest pain patients J. Am. Coll. Cardiol., March 17, 2004; 43(6): 958 - 965. [Abstract] [Full Text] [PDF]
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D. A. Morrow, J. A. de Lemos, M. S. Sabatine, S. A. Murphy, L. A. Demopoulos, P. M. DiBattiste, C. H. McCabe, C. M. Gibson, C. P. Cannon, and E. Braunwald Evaluation of B-type natriuretic peptide for risk assessment in unstable Angina/Non-ST-elevation myocardial infarction: B-type natriuretic peptide and prognosis in TACTICS-TIMI 18 J. Am. Coll. Cardiol., April 16, 2003; 41(8): 1264 - 1272. [Abstract] [Full Text] [PDF]
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D. A. Morrow, J. A. de Lemos, M. S. Sabatine, and E. M. Antman The Search for a Biomarker of Cardiac Ischemia Clin. Chem., April 1, 2003; 49(4): 537 - 539. [Full Text] [PDF]
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N. V. Bhagavan, E. M. Lai, P. A. Rios, J. Yang, A. M. Ortega-Lopez, H. Shinoda, S. A.A. Honda, C. N. Rios, C. E. Sugiyama, and C.-E. Ha Evaluation of Human Serum Albumin Cobalt Binding Assay for the Assessment of Myocardial Ischemia and Myocardial Infarction Clin. Chem., April 1, 2003; 49(4): 581 - 585. [Abstract] [Full Text] [PDF]
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F. S. Apple, M. M. Murakami, L. A. Pearce, and C. A. Herzog Predictive Value of Cardiac Troponin I and T for Subsequent Death in End-Stage Renal Disease Circulation, December 3, 2002; 106(23): 2941 - 2945. [Abstract] [Full Text] [PDF]
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 M. Panteghini Acute Coronary Syndrome: Biochemical Strategies in the Troponin Era Chest, October 1, 2002; 122(4): 1428 - 1435. [Abstract] [Full Text] [PDF]
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J. A. de Lemos, D. A. Morrow, C. M. Gibson, S. A. Murphy, M. S. Sabatine, N. Rifai, C. H. McCabe, E. M. Antman, C. P. Cannon, and E. Braunwald The prognostic value of serum myoglobin in patients with non-ST-segment elevation acute coronary syndromes: Results from the TIMI 11B and TACTICS-TIMI 18 studies J. Am. Coll. Cardiol., July 17, 2002; 40(2): 238 - 244. [Abstract] [Full Text] [PDF]
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G. C. Wong, D. A. Morrow, S. Murphy, N. Kraimer, R. Pai, D. James, D. H. Robertson, L. A. Demopoulos, P. DiBattiste, C. P. Cannon, et al. Elevations in Troponin T and I Are Associated With Abnormal Tissue Level Perfusion: A TACTICS-TIMI 18 Substudy Circulation, July 9, 2002; 106(2): 202 - 207. [Abstract] [Full Text] [PDF]
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D. Uettwiller-Geiger, A. H.B. Wu, F. S. Apple, A. W. Jevans, P. Venge, M. D. Olson, C. Darte, D. L. Woodrum, S. Roberts, and S. Chan Multicenter Evaluation of an Automated Assay for Troponin I Clin. Chem., June 1, 2002; 48(6): 869 - 876. [Abstract] [Full Text] [PDF]
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D. A. Colantonio, W. Pickett, R. J. Brison, C. E. Collier, and J. E. Van Eyk Detection of Cardiac Troponin I Early after Onset of Chest Pain in Six Patients Clin. Chem., April 1, 2002; 48(4): 668 - 671. [Full Text] [PDF]
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G. P. Armstrong, A. N. Barker, H. Patel, and H. H. Hart Reference Interval for Troponin I on the ACS:Centaur Assay: A Recommendation Based on the Recent Redefinition of Myocardial Infarction Clin. Chem., January 1, 2002; 48(1): 198 - 199. [Full Text] [PDF]
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 D. A. Morrow, C. P. Cannon, N. Rifai, M. J. Frey, R. Vicari, N. Lakkis, D. H. Robertson, D. A. Hille, P. T. DeLucca, P. M. DiBattiste, et al. Ability of Minor Elevations of Troponins I and T to Predict Benefit From an Early Invasive Strategy in Patients With Unstable Angina and Non-ST Elevation Myocardial Infarction: Results From a Randomized Trial JAMA, November 21, 2001; 286(19): 2405 - 2412. [Abstract] [Full Text] [PDF]
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I. A. Khan, N. Wattanasuwan, N. J. Mehta, A. Tun, N. Singh, H. K. Singh, B. C. Vasavada, and T. J. Sacchi Prognostic value of serum cardiac troponin I in ambulatory patients with chronic renal failure undergoing long-term hemodialysis: A two-year outcome analysis J. Am. Coll. Cardiol., October 1, 2001; 38(4): 991 - 998. [Abstract] [Full Text] [PDF]
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S. Kennon, C. P. Price, P. G. Mills, K. Ranjadayalan, J. Cooper, H. Clarke, and A. D. Timmis The effect of aspirin on C-reactive protein as a marker of risk in unstable angina J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1266 - 1270. [Abstract] [Full Text] [PDF]
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F. S. Apple and A. H.B. Wu Myocardial Infarction Redefined: Role of Cardiac Troponin Testing Clin. Chem., March 1, 2001; 47(3): 377 - 379. [Full Text] [PDF]
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R. H. Christenson, S. H. Duh, W. R. Sanhai, A. H.B. Wu, V. Holtman, P. Painter, E. Branham, F. S. Apple, M. Murakami, and D. L. Morris Characteristics of an Albumin Cobalt Binding Test for Assessment of Acute Coronary Syndrome Patients: A Multicenter Study Clin. Chem., March 1, 2001; 47(3): 464 - 470. [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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R. J. de Winter Risk stratification with cardiac troponin I in acute coronary syndromes J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1824 - 1826. [Full Text] [PDF]
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R. Labugger, L. Organ, C. Collier, D. Atar, and J. E. Van Eyk Extensive Troponin I and T Modification Detected in Serum From Patients With Acute Myocardial Infarction Circulation, September 12, 2000; 102(11): 1221 - 1226. [Abstract] [Full Text] [PDF]
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J. Ravkilde Risk Stratification in Acute Coronary Syndrome Using Cardiac Troponin I Clin. Chem., April 1, 2000; 46(4): 443 - 444. [Full Text] [PDF]
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