Kinetics of high-sensitivity cardiac troponin T or troponin I compared to creatine kinase in patients with revascularized acute myocardial infarction

Abstract

Kinetic of hs-cTnT and not cTnI differs from CK. The role of hs-cTnT in prognosis has to be investigated.

The 99th percentile of reference population for cTnI and cTnT assay: methodology, pathophysiology and clinical implications

“…Furthermore, since cTnI and cTnT are present in the sarcomeric complex in a molecular ratio of 1:1, these differences between the circulating cTns are probably related to differences in intra- [130] or extra-cellular [131][132][133] catabolism and the peripheral turnover of cTnI and cTnT. A recent study [134] found that circulating levels of cTnT, unlike cTnI, have a diurnal rhythm, thus bearing out the hypothesis that there are some differences in the release from cardiomyocytes and/or peripheral turnover between cTnI and cTnT.…”

Rebuttal: Comparative prognostic value of postprocedural creatine kinase myocardial band and high‐sensitivity troponin T in patients with non‐ST‐segment elevation myocardial infarction undergoing percutaneous coronary intervention

“…This was recognized and discussed in our study, as well. As the authors have previously shown in patients with STEMI, all three biomarkers-hs-cTnT, hs-cTnI, and CK-MB-show a 1st peak 10.7 hr to 11.8 hr after reperfusion [4,5]. However, only hs-cTnT, but not hs-cTnI or CK-MB, show a biphasic kinetics with a 2nd peak occurring 76.9 hr after reperfusion [4,5].…”

“…Second, the authors correctly pointed out to the biphasic kinetics of hs‐cTnT elevation in reperfused patients with STEMI and the fact that only the 1st postprocedural hs‐cTnT peak was analyzed and compared with peak creatine kinase myocardial band (CK‐MB) in our study. This was recognized and discussed in our study, as well.…”

“…In patients with NSTEMI, postprocedural hs-cTnT may be associated with prognosis because it consists of both PCI-related and baseline hs-TnT fraction which reflects the extent of spontaneous ischemic damage in these patients, and of the 2, the latter is the main determinant of prognostic information. Likewise, being aware of oversensitivity of hs-cTnT in detecting myocardial damage after PCI, we assessed several multiples of the ULN of postprocedural hs-cTnT and found that postprocedural hs-cTnT was associated with mortality only for elevations >70 times the ULN cutoff [1].Second, the authors correctly pointed out to the biphasic kinetics of hs-cTnT elevation in reperfused patients with STEMI [4,5] and the fact that only the 1st postprocedural hs-cTnT peak was analyzed and compared with peak creatine kinase myocardial band (CK-MB) in our study. This was recognized and discussed in our study, as well.…”

Cardiac enzyme elevation after coronary revascularization

“…It is important to note the differences in kinetics of CK‐MB, cTn, and hs‐TnT. In patients with acute MI, while the peak values of CK‐MB and cTn are followed by linear decreases post successful PCI, the levels of hs‐TnT follow a biphasic curve, with a second peak noted at 82h . There have not been studies looking at associations between the two hs‐cTnT peaks and mortality.…”