Received on July 22, 2008
Accepted on February 18, 2009

Proteomics and Protein Markers

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

^* To whom correspondence should be addressed. 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 () 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.