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Proteomics and Protein Markers |
1 Departments of Laboratory Medicine and Pathology and 2 Emergency Medicine, Hennepin County Medical Center, University of Minnesota School of Medicine, Minneapolis, MN; 3 Biostatistical Consulting, Minot, ND.
aAddress correspondence to this author at: Hennepin County Medical Center, Clinical Laboratories P4, 701 Park Ave., Minneapolis, MN 55415. Fax 612-904-4229; e-mail apple004{at}umn.edu.
Background: We determined the diagnostic accuracy of the Advia Centaur TnI-Ultra assay for detecting myocardial infarction (MI) and assessing risk of adverse events in patients presenting with ischemic symptoms suggestive of acute coronary syndrome.
Methods: We measured cardiac troponin I (cTnI) on admission and 6–24 h after admission (follow-up) in plasma specimens from 371 consecutive patients. The end point was the first of cardiac event or death within 60 days. We estimated survival curves using the Kaplan-Meier method and compared groups with the log rank statistic.
Results: MI was established in 49 patients (13%). Clinical sensitivities and specificities for MI based on the 99th percentile (0.04 µg/L) were 74% and 84%, respectively, on admission and 94% and 81% at follow-up. ROC curves showed significantly higher accuracy for MI in the follow-up specimen compared with admission (P = 0.001). Overall there were 2 cardiac deaths, 1 noncardiac death, 49 MIs, 7 coronary artery bypass grafts, and 36 percutaneous coronary interventions in 59 patients during follow-up. The event rate in those with cTnI <0.006 µg/L was significantly lower than in groups with cTnI 0.006–0.04 µg/L, >0.04–0.10 µg/L, or >0.10 µg/L (2.8% vs 11.1%, 24.1%, 55.1%, respectively; P <0.0001). Relative risks for the increasing cTnI cutoff groups were 3.9 (95% CI 1.2–13), 8.9 (2.4–34), and 25 (7.3–82) after adjustment for age, diabetes, history of hypertension, previous MI, and estimated glomerular filtration rate.
Conclusions: The TnI-Ultra assay is a sensitive, early diagnostic biomarker for MI and an independent predictor of adverse events at any measurable cTnI in patients with symptoms of acute coronary syndrome.
The following articles in journals at HighWire Press have cited this article:
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  T. Reichlin, W. Hochholzer, S. Bassetti, S. Steuer, C. Stelzig, S. Hartwiger, S. Biedert, N. Schaub, C. Buerge, M. Potocki, et al. Early Diagnosis of Myocardial Infarction with Sensitive Cardiac Troponin Assays N. Engl. J. Med., August 27, 2009; 361(9): 858 - 867. [Abstract] [Full Text] [PDF]
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T. Keller, T. Zeller, D. Peetz, S. Tzikas, A. Roth, E. Czyz, C. Bickel, S. Baldus, A. Warnholtz, M. Frohlich, et al. Sensitive Troponin I Assay in Early Diagnosis of Acute Myocardial Infarction N. Engl. J. Med., August 27, 2009; 361(9): 868 - 877. [Abstract] [Full Text] [PDF]
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D. A. Morrow Clinical Application of Sensitive Troponin Assays N. Engl. J. Med., August 27, 2009; 361(9): 913 - 915. [Full Text] [PDF]
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 F. S. Apple A New Season for Cardiac Troponin Assays: It's Time to Keep a Scorecard Clin. Chem., July 1, 2009; 55(7): 1303 - 1306. [Full Text] [PDF]
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 T. Reichlin, W. Hochholzer, C. Stelzig, K. Laule, H. Freidank, N. G. Morgenthaler, A. Bergmann, M. Potocki, M. Noveanu, T. Breidthardt, et al. Incremental value of copeptin for rapid rule out of acute myocardial infarction. J. Am. Coll. Cardiol., June 30, 2009; 54(1): 60 - 68. [Abstract] [Full Text] [PDF]
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F. S. Apple, L. A. Pearce, S. W. Smith, J. M. Kaczmarek, and M. M. Murakami 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., May 1, 2009; 55(5): 930 - 937. [Abstract] [Full Text] [PDF]
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 A. S. Jaffe and F. S. Apple Refining Our Criteria: A Critical Challenge Am J Clin Pathol, January 1, 2009; 131(1): 11 - 13. [Full Text] [PDF]
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K. M. Eggers, A. S. Jaffe, L. Lind, P. Venge, and B. Lindahl Value of Cardiac Troponin I Cutoff Concentrations below the 99th Percentile for Clinical Decision-Making Clin. Chem., January 1, 2009; 55(1): 85 - 92. [Abstract] [Full Text] [PDF]
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F. S. Apple, S. W. Smith, L. A. Pearce, and M. M. Murakami Assessment of the Multiple-Biomarker Approach for Diagnosis of Myocardial Infarction in Patients Presenting with Symptoms Suggestive of Acute Coronary Syndrome Clin. Chem., January 1, 2009; 55(1): 93 - 100. [Abstract] [Full Text] [PDF]
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P. Venge, S. James, L. Jansson, and B. Lindahl Clinical Performance of Two Highly Sensitive Cardiac Troponin I Assays Clin. Chem., January 1, 2009; 55(1): 109 - 116. [Abstract] [Full Text] [PDF]
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 E. A. Dawson, G. P. Whyte, M. A. Black, H. Jones, N. Hopkins, D. Oxborough, D. Gaze, R. E. Shave, M. Wilson, K. P. George, et al. Changes in vascular and cardiac function after prolonged strenuous exercise in humans J Appl Physiol, November 1, 2008; 105(5): 1562 - 1568. [Abstract] [Full Text] [PDF]
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