Key result
Post-mortem troponin T is ~3.8-fold higher than ante-mortem levels but unlinked to cardiac death.
Why the study?
Sudden cardiac death due to AMI comprises a significant proportion of autopsy cases, and although troponin is a sensitive and specific indicator of myocardial infarction, histological evaluation remains the diagnostic gold standard.
Cross-Sectional (n=239)
No
Post-mortem troponin T should not guide cause-of-death determination; leaves open the need for prospective validation of timing and degradation effects.
Cardiac deaths accounted for 50% of all deaths in the developed and one fourth in the developing world.Sudden cardiac death due to an acute myocardial infarction (AMI) comprises a significant proportion of autopsy cases.Troponin levels act as a specific and sensitive indicator of myocardial infarction.However, histological evaluation for the diagnosis of AMI remains the gold standard.This retrospective study was based on the total of 154 post-mortem cases and total of 85 emergency cases with Trop T samples sent for laboratory investigation in year 2016 at Hospital Kuala Lumpur.From the post-mortem cases, Trop T values for non-cardiac related death cases (5.322 ng/ml) were higher than cardiac-related death (4.916 ng/ml) with no significant difference between them although Trop T values were highly sensitive to myocardial infarction but the limitation was on the specificity.There was also no correlation between post-mortem Trop T levels to the cardiac-related cause of death using post-mortem cases.The minimum Trop T value amongst the MI post-mortem cases was assumed to be the cut-off value i.e. ≥ 0.390 ng/ml.Although the elevated Trop T values might concur with the diagnosis of acute coronary syndrome causing subsequent death, there were multiple factors that can attribute to an elevated Trop T results after death including post-mortem performing interval and depending on the severity of myocardial damage at the time of death.Eventually 38 emergency cases certified with MI were compared with 8 post-mortem cases certified with MI.The mean for post-mortem (PM) cases (5.065 ± 4.498 ng/ml) was much higher than those ante-mortem (AM) case (1.327 ± 1.918 ng/ml).Hence, there was statistically significant difference between ante-mortem and post-mortem cases presented with myocardial infarction.As such, post-mortem Trop T level could probably not be used to reflect the ante-mortem Trop T level to diagnose myocardial infarction.In addition, the effect of post-mortem performing interval was also statistically significant between interval of < 12 hours and 12 -48 hours.A prospective study should be conducted by using the same patient diagnosed with myocardial infarction to analyse the ante-mortem and post-mortem Trop T value.
No takes yet. Share an insight, caveat, or question.
PS et al. (2017) conducted a cross-sectional in Sudden cardiac death and acute myocardial infarction (n=239). Post-mortem Troponin T level vs. Ante-mortem Troponin T level and non-cardiac death cases was evaluated on Mean Troponin T level (ng/ml) in myocardial infarction cases (post-mortem vs ante-mortem) (p=0.005). Post-mortem Troponin T levels in myocardial infarction cases were significantly higher than ante-mortem levels (5.065 vs 1.327 ng/ml, p=0.005) and did not correlate with cardiac cause of death.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: