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Role of Monitoring Changes in Sensitive Cardiac Troponin I Assay Results for Early Diagnosis of Myocardial Infarction and Prediction of Risk of Adverse Events

¹ Hennepin County Medical Center and University of Minnesota, Department of Laboratory Medicine and Pathology and Emergency Medicine, Minneapolis, MN.

^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 sought to determine the diagnostic accuracy of the cardiac troponin I (cTnI) VITROS® Troponin I-ES assay for early detection of acute myocardial infarction (AMI) and for risk prediction of adverse events in patients with symptoms of acute coronary syndrome (ACS).

Methods: cTnI was measured on admission and approximately 6 h postadmission in 381 patients. The 99th percentile cTnI concentration (0.034 µg/L) and change [delta ()] between admission and follow-up concentrations were evaluated in diagnostic sensitivity and specificity calculations. Risk of cardiac event or death within 60 days was evaluated by Cox proportional hazards regression.

Results: AMI occurred in 52 patients. Diagnostic sensitivities (95% CI) of admission and follow-up cTnIs for AMI were 69% (55%–81%) and 94% (84%–99%), respectively. The corresponding specificities (95% CI) were 78% (73%–82%) and 81% (77%–85%), and ROC curve areas were 0.82 vs 0.96 (P < 0.001). Deltas between admission and follow-up cTnI >30% had a sensitivity of 75% (95% CI 61%–86%) and a specificity of 91% (95% CI 87%–94%). During follow-up, 1 cardiac death, 2 noncardiac deaths, 52 AMIs, 6 coronary artery bypass grafts, and 43 percutanous coronary interventions occurred in 62 patients. A cTnI >30%, when added to either initial cTnI >0.034 µg/L or follow-up cTnI >0.034 µg/L, improved risk stratification for cardiac event or death (P < 0.001).

Conclusions: Admission cTnI measured by the VITROS ES assay is a sensitive biomarker for detection of AMI. Utilizing >30% cTnI in addition to either the baseline or follow-up concentration improved both specificity and risk assessment in patients presenting with symptoms of ACS.

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				P. A. Kavsak, X. Wang, D. T. Ko, A. R. MacRae, and A. S. Jaffe Short- and Long-Term Risk Stratification Using a Next-Generation, High-Sensitivity Research Cardiac Troponin I (hs-cTnI) Assay in an Emergency Department Chest Pain Population Clin. Chem., October 1, 2009; 55(10): 1809 - 1815. [Abstract] [Full Text] [PDF]

				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]

				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]