Temporal Evolution of Serum Concentrations of High‐Sensitivity Cardiac Troponin During 1 Year After Acute Coronary Syndrome Admission

Abstract

Background Detailed insights in temporal evolution of high‐sensitivity cardiac troponin following acute coronary syndrome (ACS) are currently missing. We aimed to describe and compare the post‐ACS kinetics of high‐sensitivity cardiac troponin I (hs‐cTnI) and high‐sensitivity cardiac troponin T (hs‐cTnT), and to determine their intra‐ and interindividual variation in clinically stable patients. Methods and Results We determined hs‐cTnI (Abbott) and hs‐cTnT (Roche) in 1507 repeated blood samples, derived from 191 patients with ACS (median, 8/patient) who remained free from adverse cardiac events during 1‐year follow‐up. Post‐ACS kinetics were studied by linear mixed‐effect models. Using the samples collected in the 6‐ to 12‐month post‐ACS time frame, patients were then considered to have chronic coronary syndrome. We determined (differences between) the average hs‐cTnI and average hs‐cTnT concentration, and the intra‐ and interindividual variation for both biomarkers. Compared with hs‐cTnT, hs‐cTnI peaked higher (median 3506 ng/L versus 494 ng/L; P <0.001) and was quicker below the biomarker‐specific upper reference limit (16 versus 19 days; P <0.001). In the post–6‐month samples, hs‐cTnI and hs‐cTnT showed modest correlation ( r spearman =0.60), whereas the average hs‐cTnT concentration was 5 times more likely to be above the upper reference limit than hs‐cTnI. The intraindividual variations of hs‐cTnI and hs‐cTnT were 14.0% and 18.1%, while the interindividual variations were 94.1% and 75.9%. Conclusions Hs‐cTnI peaked higher after ACS and was quicker below the upper reference limit. In the post–6‐month samples, hs‐cTnI and hs‐cTnT were clearly not interchangeable, and average hs‐cTnT concentrations were much more often above the upper reference limit than hs‐cTnI. For both markers, the within‐patient variation fell largely below beween‐patient variation. Registration URL: https://www.trialregister.nl ; unique identifiers: NTR1698 and NTR1106.

Caplacizumab for treating subacute intra-stent thrombus occurring despite efficacious double anti-platelet treatment and anticoagulation: a case report

“…The treatment was rapidly efficacious from a biological point of view, with suppression of VWF activity, reduction of VWF antigen, and Factor VIII activity ( Figure 3 ). Of note, hs-cTnT, which after Day 5 failed to decrease further as expected, 4 , 5 dropped from persistently elevated levels from 450 to 139 ng/mL ( Figure 4 ). Caplacizumab was also efficient from a clinical point of view, with no recurrence of chest pain and improvement of dyspnoea.…”

“…A second CA performed on Day 7 because of persistent chest pain and a failure of troponin levels to decrease 4 , 5 demonstrated a large filling defect within the stent in the LAD artery compatible with subacute intra-stent thrombosis ( Figure 2 ). Antithrombotic treatment was completed with glycoprotein (GP) IIb–IIIa inhibition (eptifibatide 180 mcg/kg IV bolus followed by 2 mcg/kg/min infusion for 12 h).…”

Association of Serial High-Sensitivity Cardiac Troponin T With Subsequent Cardiovascular Events in Patients Stabilized After Acute Coronary Syndrome

“…The optimal timing of the first hsTnT measurement that best reflects steady state concentration following an ACS event remains unclear. Prior studies have suggested that stabilization of hsTnT may occur at a median of 30 days following ACS . However, whether differences in the extent of the initial infarct alter this temporal trajectory remains less clear.…”

Cardiac Troponin Serum Concentration Measurement Is Useful Not Only in the Diagnosis of Acute Cardiovascular Events

“…No significant difference was found between the troponin isotypes (troponin T vs. troponin I) [ 92 ]. On the other hand, in patients at six months after acute coronary syndrome, mean troponin T is more often above the upper limit of the reference range than troponin I [ 93 ].…”