Official journal of the Slovak Society of Cardiology,
Slovak Society of Hypertension and Slovak Association for Cardiac Arrhythmias

Cardiology Letters 2016, 25(2):79-84

Where is the place of serum high sensitivity troponin T in the early diagnostic of acute myocardial infarction?

Murín J1, Hricák V2, Kamenský G3, Margóczy R4, Daňová K5
1 I. interná klinika LFUK a UNB, Nemocnica Staré Mesto, Bratislava
2 Oddelenia akútnej kardiológie, NÚSCH, a.s., Bratislava
3 V. interná klinika LFUK a UNB, Nemocnica Ružinov, Bratislava
4 Oddelenia všeobecnej kardiológie, SÚSCCH, a.s., Banská Bystrica
5 Oddelenia laboratórnej medicíny, NÚSCH, a.s., Bratislava, Slovenská republika

In cardiovascular morbidity and mortality in Slovakia acute coronory syndromes feature importantly and this information is presented in our SLOVAKS-1 and SLOVAKS-2 registries. They show our diagnostic and treatment practices here and also present prognostic data about these patients. If we want to improve prognosis of these patients, then we need to shorten the diagnostic time period and improve diagnosis of acute myocardial infarction - then such a patient can get optimal treatment earlier. Two clinical studies (APACE and TRAPID-AMI) first developed, and later confirmed, in routine clinical prac­ tice in patients with acute coronary syndrome, a diagnostic biomarker (hs cTnT) algorithm of examination: "0 hour and 1st hour" (0h/1h), to rule-in or rule-out an acute myocardial infarction. In 78% of patients it was possible to rule-in or rule-out myocardial infarction and only 22% of patients were in need of a prolonged diagnostic time interval. Therefore many of these patients can be discharged home from the emergency department (rule-out of infarction) and other patients can be admitted immediately to the intensive care unit and early treatment (rule-in of infarction) according to guidelines. We present the results of our small group of patients. It is important to implement this algorithm of diagnosis of acute myocardial infarction into clinical practice in our country also.

Keywords: acute coronary syndrome; acute myocardial infarction; biomarker hs cTnT; acute myocardial infarction treatment

Published: February 1, 2016  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Murín J, Hricák V, Kamenský G, Margóczy R, Daňová K. Where is the place of serum high sensitivity troponin T in the early diagnostic of acute myocardial infarction? Cardiology Letters. 2016;25(2):79-84.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Center for Disease Control and Prevention. Vital Statistics Public Use Data Files - 2008 Mortality Multiple Causes Files At: http://www.cdc.gov/nchs/data_access/Vitalstatsonline.htm#Mortality_Multiple. Assessed September 23, 2011
    2. Zdravotnícka ročenka Slovenskej republiky 2013. Bratislava: Národné centrum zdravotníckych informácií; 2015:13.
    3. Fox KA, Eagle KA, Gore JM, et. al. The global registry of acute coronary events, 1999 - 2009, GRACE. Heart 2010;96:1095-1101. Go to original source...
    4. Studenčan M, Kovář F, Hricák V, et al. Aktuálne trendy v starostlivosti o pacientov so STEMI v Slovenskej republike. Analýza výsledkov registra SLOVAKS-2 z roku 2011. Cardiology Lett. 2013,22:115-124.
    5. Kovář F, Studenčan M, Hricák V, et al. Súčasný stav manažmentu pacientov s NSTE-AKS v Slovenskej republike. Analýza výsledkov registra SLOVAKS-2 z roku 2011. Cardiology Lett. 2014;23:115-125.
    6. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol 2012;60:15811598. Go to original source...
    7. Thygesen K, Mair J, Katus H, et al. Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J. 2010;31:2197-2204. Go to original source...
    8. Thygesen K, Alpert JS, White HD, et al. Universal definition myocardial infarction. Circulation. 2007;116:2634-2653. Go to original source...
    9. Apple FS, Wu AH, Jaffe AS. European Society of Cardiology and American College of Cardiology guidelines for redefinition of myocardial infarction: how to use existing assays clinically and for clinical trials. Am Heart J 2002;144:981-986. Go to original source...
    10. Giannitsis E, Kurz K, Hallermayer K, et al. Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem. 2010;56:254-261. Go to original source...
    11. Reichlin T, Hochholzer W, Bassetti S, et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med. 2009;361:858-867. Go to original source...
    12. Reichlin T, Irfan A, Twerenbold R, et al. Utility of absolute and relative changes in cardiac troponin concentrations in the early diagnosis of acute myocardial infarction. Circulation 2011;124:136-145. Go to original source...
    13. Loppi G, Montagnana M, Guidi GC. The clinical dilemma of positive results of high-sensitive troponin assays. Am J Cardiol. 2009;103:1332. Go to original source...
    14. Morrow DA, Cannon CP, Jesse RI, et al. National Academy of Clinical Biochemistry Laboratory Medicine practice guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes. Clin Chem. 2007;53:532-574.
    15. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J http://dx.doi.org/10.1093/eurheartj/ehv320 Go to original source...
    16. Mueller Ch, Giannitsis E, Christ M, et al. Multicenter evaluation of a 0-hour/1-hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T. Ann Emergen Medicine, in Press, Corrected Proof, Available online 12 January 2016
    17. Thygesen K, Mair J, Giannitsis E, et al. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur Heart J 2012;33:2252-2257. Go to original source...
    18. Mueller C. Biomarkers and acute coronary syndromes: an update. Eur Heart J 2014;35:552-556. Go to original source...
    19. Cullen L, Mueller C, Parsonage WA, et al. Validation of highsensitivity troponin I in a 2-hour diagnostic strategy to assess 30-day outcomes in emergency department patients with possible acute coronary syndrome. J Am Coll Cardiol 2013;62:1242-1249. Go to original source...
    20. Than M, Aldous S, Lord SJ, et al. A 2-hour diagnostic protocol for possible cardiac chest pain in the emergency department: a randomized clinical trial. JAMA Intern Med 2014;174:5158. Go to original source...
    21. Möckel M, Searle J, Hamm C, et al. Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study. Eur Heart J 2015;36:369-376. Go to original source...
    22. Zellweger C, Wildi K, Twerenbold R, et al. Use of copeptin and high-sensitive cardiac troponin T for diagnosis and prognosis in patients with diabetes mellitus and suspected acute myocardial infarction. Int J Cardiol 2015;190:190-197. Go to original source...
    23. Reichlin T, Schindler C, Drexler B, et al. One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med 2012;172:1211-1218. Go to original source...
    24. Reichlin T, Twerenbold R, Wildi K, et al. Prospective validation of a 1-hour algorithm to rule-out and rule-in acute myocardial infarction using a high-sensitivity cardiac troponin T assay. CMAJ 2015;187:E243-E252. Go to original source...
    25. Anderson JL, Adams CD, Antman EM, et al. 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 guidelines for the management of patients with unstable angina/nonST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;123:e426e579. Go to original source...
    26. Zhelev Z, Hyde C, Youngman E, et al. Diagnostic accuracy of single baseline measurement of Elecsys troponin T high-sensitive assay for diagnosis of acute myocardial infarction in emergency department: systematic review and meta-analysis. BMJ 2015;350:h15. Go to original source...
    27. Bandstein N, Ljung R, Johanssson M, et al. Undetectable high sensitivity cardiac troponin T level in the emergency department and risk of myocardial infarction. J Am Coll Cardiol 2014;63:2569-2578. Go to original source...
    28. Body R, Carley S, McDowell G, et al. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay. J Am Coll Cardiol 2011;58:1332-1339. Go to original source...
    29. Rubini Giménez M, Hoeller R, Reichlin T, et al. Rapid rule out of acute myocardial infarction using undetectable levels of high-sensitivity cardiac troponin. Int J Cardiol. 2013;168:38963901. Go to original source...

    Return to the content