In patients with STEMI treated by PCI, hs-cTnT exhibited a biphasic kinetic curve with a second peak at 76.9h, contrasting with the log-linear decrease observed for hs-cTnI and s-cTnI assays.
Cohort (n=106)
No
Do the release kinetics of high-sensitivity cardiac troponin T and I differ in patients with STEMI treated by primary percutaneous coronary intervention?
The biphasic release kinetics of hs-cTnT, contrasting with the linear decrease of hs-cTnI, is clinically relevant for diagnosing reinfarction in the days following a STEMI.
PURPOSE: Cardiac biomarkers including troponins are the cornerstone of the biological definition of acute myocardial infarction. New high-sensitivity cardiac assays determining troponin T (hs-cTnT) as well as I ((hs-cTnI) from Abbott and s-cTnI from Siemens) raise concerns because of their unclear kinetics following the peak. AIMS: This study aims to compare kinetics of creatine kinases, hs-cTnT, hs-cTnI and s-cTnI in patients with ST-segment elevation myocardial infarction (STEMI) treated by percutaneous coronary intervention. METHODS: We prospectively studied 106 consecutive patients admitted in our institution for STEMI and treated by percutaneous coronary intervention. We evaluated for all the patients simultaneously kinetics of creatine kinases, hs-cTnT (Roche) and two different cTnIs (hs-cTnI from Abbott and s-cTnI from Siemens). Modelling of kinetics was realized using mixed effects with cubic splines. RESULTS: Kinetics of markers showed a first peak at 10.7h (8.0-12.0) for creatine kinases, 11.8h (10.4-13.3) for hs-cTnT (Roche); 11.8h (10.7-11.8) for hs-cTnI from Abbott and 10.2h (8.7-11.6) for s-cTnI from Siemens, respectively. This peak was followed by a nearly log linear decrease for hs-cTnI/s-cTnI and creatine kinases in contrast to hs-cTnT, which appeared with a biphasic shape curve marked by a second peak at 76.9h (69.5-82.8). The analysis of the decrease in percentage of the peak value at 77h showed that hs-cTnT follows a twice lower decrease than other markers. CONCLUSION: Kinetics of hs-cTnT, hs-cTnI and s-cTnI differ significantly with a linear decrease regarding both cTnI assays contrasting with a biphasic shape curve for hs-cTnT. This is of importance for clinical management of patients in routine settings especially in follow-up after STEMI including the suspicion of reinfarction.
Laugaudin et al. (Tue,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=106). High-sensitivity cardiac troponin T (hs-cTnT) vs. High-sensitivity cardiac troponin I (hs-cTnI) and s-cTnI was evaluated on Kinetics of creatine kinases, hs-cTnT, hs-cTnI and s-cTnI. In patients with STEMI treated by PCI, hs-cTnT exhibited a biphasic kinetic curve with a second peak at 76.9h, contrasting with the log-linear decrease observed for hs-cTnI and s-cTnI assays.