Cardiac troponin and defining myocardial infarction

Kaier, Thomas E; Alaour, Bashir; Marber, Michael

doi:10.1093/cvr/cvaa331

Cited by 24 publications

(16 citation statements)

References 131 publications

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“…The use of cTnI is firmly established for the early diagnosis of acute coronary syndrome ( 16 ). Cardiac-specific troponins are elevated in blood following cardiac injury by the mechanism of necrosis, apoptosis, increased membrane permeability of cardiomyocytes and decreased clearance ( 1 ). Both cTnI and cTnT are considered the gold-standard biomarkers for detection of myocardial injury, but cTnI is different from cTnT in its kinetic characteristics and clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Association between cardiac troponin testing at scheduled admission and mortality in patients with comorbidities

Oh¹,

Lee²,

Park³

et al. 2023

Ann Transl Med

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Background: Cardiac troponin I (cTnI) is a gold-standard biomarker for detecting myocardial infarction.Recently, the prognostic role of cTnI was reported for stable coronary artery disease and other chronic diseases. This study aimed to evaluate the usefulness of cTnI testing at scheduled admission of patients with comorbidities.Methods: We retrospectively enrolled patients with comorbidities who were admitted through the outpatient clinic from April 2010 to December 2018. The enrolled patients were divided into two groups depending on whether cTnI was measured at admission. The primary endpoint was the mortality rate at one year after admission. Secondary endpoints included 30-day and in-hospital mortality rates.Results: A population of 50,119 patients was divided into two groups, with 43,974 (87.8%) patients included in the no cTnI group and 6,145 (12.2%) patients included in the cTnI group. The multivariable analysis showed a reduction of mortality at one year in the cTnI group [5.9% vs. 3.8%, hazard ratio (HR) =0.78; 95% confidence interval (CI): 0.68-0.89; P<0.001]. Among 5,882 propensity score-matched pairs, this trend persisted, and the mortality rate was significantly lower in the cTnI group (5.3% vs. 3.9%, HR =0.77; 95% CI: 0.65-0.91; P=0.002). Patients with cTnI measurements taken at admission underwent cardiac evaluation and therapy more frequently. Conclusions:The measurement of cTnI at scheduled admission may affect the mortality during one year of follow-up. Further studies are needed to validate our results.

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Section: Discussionmentioning

confidence: 99%

“…Cardiac troponin I (cTnI) is highly specific to cardiac myocytes and has become a marker of choice for the evaluation of myocardial injury ( 1 ). It has been subsequently included in the definition of acute myocardial infarction and is regarded as the gold-standard biomarker for diagnosis ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

Association between cardiac troponin testing at scheduled admission and mortality in patients with comorbidities

Oh¹,

Lee²,

Park³

et al. 2023

Ann Transl Med

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“…As known, CAG is an invasive procedure, and patients may be allergic to the contrast agent, which will cause severe hypersensitivity reactions and can be life‐threatening 11 . Many scholars have explored the influencing factors related to the degree of stenosis in patients with CHD, suggesting that the history of diabetes, blood glucose level, white blood cell count, serum troponin, fibrinogen level, fibrinogen to albumin ratio, BNP level, total bilirubin, and uric acid level were independent factors on the severity of coronary artery lesions 12–18 . However, to date, there is still a lack of non‐invasive and efficient methods to predict the need for PCI in patients with coronary artery disease.…”

Section: Discussionmentioning

confidence: 99%

Development of a risk score model for the prediction of patients needing percutaneous coronary intervention

Wang

Lin

Wang

2023

Clinical Laboratory Analysis

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Background:The incidence of coronary heart disease (CHD) is increasing worldwide.The need for percutaneous coronary intervention (PCI) is determined by coronary angiography (CAG). As coronary angiography is an invasive and risky test for patients, it will be of great help to develop a predicting model for the assessment of the probability of PCI in patients with CHD using the test indexes and clinical characteristics. Methods: A total of 454 patients with CHD were admitted to the cardiovascular medicine department of a hospital from January 2016 to December 2021, including 286 patients who underwent CAG and were treated with PCI, and 168 patients who only underwent CAG to confirm the diagnosis of CHD were set as the control group. Clinical data and laboratory indexes were collected. According to the clinical symptoms and the examination signs, the patients in the PCI therapy group were further split into three subgroups: chronic coronary syndrome (CCS), unstable angina pectoris (UAP), and acute myocardial infarction (AMI). The significant indicators were extracted by comparing the differences among the groups. A nomogram was drawn based on the logistic regression model, and predicted probabilities were performed using R software (version 4.1.3).Results: Twelve risk factors were selected by regression analysis; the nomogram was successfully constructed to predict the probability of needing PCI in patients with CHD.The calibration curve shows that the predicted probability is in good agreement with the actual probability (C-index = 0.84, 95% CI = 0.79-0.89). According to the results of the fitted model, the ROC curve was plotted, and the area under the curve was 0.801.Among the three subgroups of the treatment group, 17 indexes were statistically different, and the results of the univariable and multivariable logistic regression analysis revealed that cTnI and ALB were the two most important independent impact factors. Conclusion: cTnI and ALB are independent factors for the classification of CHD. A nomogram with 12 risk factors can be used to predict the probability of requiring PCI in patients with suspected CHD, which provided a favorable and discriminative model for clinical diagnosis and treatment.

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“…cTnT (40 kDa 28 ) binds tropomyosin and serves as the mechanical link anchoring the other cTn subunits to the thin filament. 29 , 30 As skeletal muscle troponin differs from both cTnI and cTnT in terms of amino acid composition, immunological techniques have allowed the development of immunoassays. These immunoassays use cTn-specific monoclonal antibodies to detect circulating cTn.…”

Section: Introductionmentioning

confidence: 99%

Cardiac troponin release following coronary artery bypass grafting: mechanisms and clinical implications

Heuts

Gollmann‐Tepeköylü

Denessen

et al. 2022

European Heart Journal

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The use of biomarkers is undisputed in the diagnosis of primary myocardial infarction (MI), but their value for identifying MI is less well studied in the postoperative phase following coronary artery bypass grafting (CABG). To identify patients with periprocedural MI (PMI), several conflicting definitions of PMI have been proposed, relying either on cardiac troponin (cTn) or the MB isoenzyme of creatine kinase, with or without supporting evidence of ischaemia. However, CABG inherently induces the release of cardiac biomarkers, as reflected by significant cTn concentrations in patients with uncomplicated postoperative courses. Still, the underlying (patho)physiological release mechanisms of cTn are incompletely understood, complicating adequate interpretation of postoperative increases in cTn concentrations. Therefore, the aim of the current review is to present these potential underlying mechanisms of cTn release in general, and following CABG in particular (Graphical Abstract). Based on these mechanisms, dissimilarities in the release of cTnI and cTnT are discussed, with potentially important implications for clinical practice. Consequently, currently proposed cTn biomarker cut-offs by the prevailing definitions of PMI might warrant re-assessment, with differentiation in cut-offs for the separate available assays and surgical strategies. To resolve these issues, future prospective studies are warranted to determine the prognostic influence of biomarker release in general and PMI in particular.

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Cardiac troponin and defining myocardial infarction

Cited by 24 publications

References 131 publications

Association between cardiac troponin testing at scheduled admission and mortality in patients with comorbidities

Association between cardiac troponin testing at scheduled admission and mortality in patients with comorbidities

Development of a risk score model for the prediction of patients needing percutaneous coronary intervention

Cardiac troponin release following coronary artery bypass grafting: mechanisms and clinical implications

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