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Eur Heart J. 2014 Sep 7;35(34):2303-11. doi: 10.1093/eurheartj/ehu188. Epub 2014 May 19.

Direct comparison of high-sensitivity-cardiac troponin I vs. T for the early diagnosis of acute myocardial infarction.

Author information

1
Department of Cardiology, University Hospital Basel, Basel, Switzerland Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar - Institut Municipal D'Investigació Mèdica, Barcelona, Spain.
2
Department of Cardiology, University Hospital Basel, Basel, Switzerland Universitäres Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
3
Department of Cardiology, University Hospital Basel, Basel, Switzerland Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
4
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
5
Laboratory Medicine, University Hospital Basel, Basel, Switzerland.
6
Department of Cardiology, University Hospital Basel, Basel, Switzerland christian.mueller@usb.ch.

Abstract

AIM:

It is unknown whether cardiac troponin (cTn) I or cTnT is the preferred biomarker in the early diagnosis of acute myocardial infarction without ST segment elevation (NSTEMI).

METHODS AND RESULTS:

In a prospective multicentre study, we measured cTnI and cTnT using clinically available high-sensitivity assays (hs-cTnI Abbott and hs-cTnT Roche) and compared their diagnostic and prognostic accuracies in consecutive patients presenting to the emergency department with acute chest pain. The final diagnosis was adjudicated by two independent cardiologists using all information pertaining to the individual patient. The mean follow-up was 24 months. Among 2226 consecutive patients, 18% had an adjudicated final diagnosis of NSTEMI. Diagnostic accuracy at presentation as quantified by the area under the receiver-operating-characteristics curve (AUC) for NSTEMI was very high and similar for hs-cTnI [AUC: 0.93, 95% confidence interval (CI) 0.92-0.94] and hs-cTnT (0.94, 95% CI: 0.92-0.94) P = 0.62. In early presenters (<3 h since chest pain onset) hs-cTnI showed a higher diagnostic accuracy (AUC: 0.92, 95% CI: 0.89-0.94) when compared with hs-cTnT AUC (0.89, 95% CI: 0.86-0.91) (P = 0.019), while hs-cTnT was superior in late presenters [AUC hs-cTnT 0.96 (95% CI: 0.94-0.96)  vs. hs-cTnI 0.94 (95% CI: 0.93-0.95); P = 0.007]. The prognostic accuracy for all-cause mortality, quantified by AUC, was significantly higher for hs-cTnT (AUC: 0.80; 95% CI: 0.78-0.82) when compared with hs-cTnI (AUC: 0.75; 95% CI: 0.73-0.77; P < 0.001).

CONCLUSION:

Both hs-cTnI and hs-cTnT provided high diagnostic and prognostic accuracy. The direct comparison revealed small but potentially important differences that might help to further improve the clinical use of hs-cTn.

KEYWORDS:

Acute myocardial infarction; High-sensitive cardiac troponin

PMID:
24842285
DOI:
10.1093/eurheartj/ehu188
[Indexed for MEDLINE]

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