Troponin I, laboratory issues, and clinical outcomes in a district general hospital: crossover study with “traditional” markers of myocardial infarction in a total of 1990 patients

Abstract

Aims: Review of the clinical outcomes and practical issues of replacing traditional cardiac enzymes with troponin I (cTnI) in a district general hospital. Methods: Crossover study of three sequential three month stages during which serial cardiac enzymes were replaced with a single cTnI measurement available at three set times within 24 hours for the duration of the second three month stage. The study was carried out in a 630 bed district general hospital with 1990 admissions of suspected cardiac ischaemia over the study period as a whole. Account was taken of seasonal factors. Results: The introduction of troponin was associated with 8.5% more patients with non-ischaemic heart disease (IHD) being discharged on the day after admission, saving approximately 107 bed days each year. Approximately 50% more patients were diagnosed with myocardial infarction during the cTnI stage. There was no increase in readmission within one month or early death with cTnI. Approximately 3% false positive and 1.5% false negative cTnI results were recorded. All false positive cTnI results were coding errors or attributable to known assay interference effects. All false negatives were potentially explained by sample timing factors. The lack of standardisation in troponin assay services impacts clinically. Conclusion: Younger patients without IHD were discharged earlier during the cTnI stage in apparent safety. Blood sample timing needs to be verified when cTnI is used as an adjunct to early discharge. There were no unexplained false positives or negatives. Standardisation related issues arose.

Cardiac Troponin I in Doberman Pinschers with Cardiomyopathy

“…The primary value of cTnI as a biomarker in humans is to detect myocardial infarcts. 1 In humans, this protein is detectable in the blood 3-12 hour after cardiac injury, peaks at 1-2 days, and dissipates by 5-10 days. 2 Persistent increases in cTnI are associated with chronic or ongoing disease processes.…”

Cardiac troponins

“…8 First, more patients with chest pain who would not have been diagnosed as having myocardial damage with conventional muscle enzyme assays are being diagnosed with myocardial infarction, even in the absence of ST segment elevation. Many of these patients are at high risk of full thickness myocardial infarction or even death in the ensuing six month period, [9][10][11][12] and have been shown to benefit prognostically from early treatment with low molecular weight heparins, 13 platelet glycoprotein IIb/IIIa receptor blockers, 14 and coronary revascularisation.…”

Recent Progress in Drug Repurposing Using Protein Variants and Amino Acids in Disease Phenotypes/Disorders

“…In the management of patients with acute chest pain, the measurement of cardiac troponins as markers of myocardial damage has produced two important Drug Repurposing -Molecular Aspects and Therapeutic Applications beneficial effects on clinical practice [39]. The first beneficial effect is that more patients with chest pain who would not have been diagnosed as having myocardial damage with conventional muscle enzyme assays are being diagnosed with myocardial infarction, even in the absence of ST-segment elevation.…”