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VOLUME 22 , ISSUE 9 ( 2018 ) > List of Articles

RESEARCH ARTICLE

The Importance of Serial Time Point Quantitative Assessment of Cardiac Troponin I in the Diagnosis of Acute Myocardial Damage

Vidyut Jain, Arindam Bose, Girish Kawthekar, Chandrabala Chhabra, Nanda Hemvani, Dhananjay S. Chitnis

Keywords : acute myocardial infarction, cardiac troponin I, non-ST-elevated MI, unstable angina,Acute coronary syndrome

Citation Information : Jain V, Bose A, Kawthekar G, Chhabra C, Hemvani N, Chitnis DS. The Importance of Serial Time Point Quantitative Assessment of Cardiac Troponin I in the Diagnosis of Acute Myocardial Damage. Indian J Crit Care Med 2018; 22 (9):629-631.

DOI: 10.4103/ijccm.IJCCM_8_16

License: CC BY-ND 3.0

Published Online: 00-09-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objective: The present study was aimed to establish a threshold value for cardiac troponin I (cTnI) for nonacute coronary syndrome (ACS) participants from the local population and also to determine the importance of serial time point estimation of cTnI in acute myocardial infarction (AMI), non-ST-elevated MI (NSTEMI), and unstable angina cases. Methods: The present study included 194 cases, admitted in ICCU with the complaint of anginal pain; 31 were diagnosed with AMI with typical electrocardiography (ECG) changes; whereas, 48 cases were diagnosed with NSTEMI. The latter group of cases was selected for the time point study of cTnI release at 0—4 h, 6—12 h, 72 h, and 144 h of admission. cTnI levels were assessed using the Abbott ARCHITECT i1000SR system. Results: ACS was clinically ruled out in 98 cases, and cTnI level for them was used to decide cTnI threshold for the non-ACS group. cTnI level was checked in 17 cases of unstable angina. The threshold value of cTnI for non-ACS participants was 0.1 ng/ml and can be considered as cut-off value for the regional population. The data suggested that the peak of cTnI levels in most of the AMI cases reached during 6—12 h. The cTnI levels were lower than 0.1 ng/ml, and no significant change in ECG was noticed in 17 cases of unstable angina. Conclusion: The present study suggested that the repeat of cTnI assay after 4—6 h of admission is required if the initial value is <3 ng/ml.


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  1. Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined — A consensus document of the joint european society of cardiology/American college of cardiology committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000;36:959-69.
  2. Wu AH, Apple FS, Gibler WB, Jesse RL, Warshaw MM, Valdes R Jr, et al. National academy of clinical biochemistry standards of laboratory practice: Recommendations for the use of cardiac markers in coronary artery diseases. Clin Chem 1999;45:1104-21.
  3. Adams JE. Utility of cardiac troponins in patients with suspected cardiac trauma or after cardiac surgery. Clin Lab Med 1997;17:613-23.
  4. Apple FS, Sharkey SW, Hoeft P, Skeate R, Voss E, Dahlmeier BA, et al. Prognostic value of serum cardiac troponin I and T in chronic dialysis patients: A 1-year outcomes study. Am J Kidney Dis 1997;29:399-403.
  5. Mair J, Wagner I, Puschendorf B, Mair P, Lechleitner P, Dienstl F, et al. Cardiac troponin I to diagnose myocardial injury. Lancet 1993;341:838-9.
  6. Adams JE 3rd, Miracle VA. Cardiac biomarkers: Past, present, and future. Am J Crit Care 1998;7:418-23.
  7. Christenson RH, National Academy of Clinical Biochemistry. National academy of clinical biochemistry laboratory medicine practice guidelines for utilization of biochemical markers in acute coronary syndromes and heart failure. Clin Chem 2007;53:545-6.
  8. Schreiber D, Brenner BE. Cardiac Markers. Heart.org (Medscape). Jan 2017. Available from: https://emedicine.medscape.com/article/811905-overview.
  9. National Institute of Health and Care Excellance. Diagnostic adoption support: Myocardial infarction (acute): Early Rule Out Using High-Sensitivity Troponin Tests (Elecsys Troponin T high-sensitive, ARCHITECT STAT High Sensitive Troponin-I and AccuTnI+3 assays). Health Technologies Adoption Programme; 2017. Available from: https://www.nice.org.uk/guidance/dg15/evidence/review-decision-april-2018-pdf-4841038189.
  10. Fonarow GC, Middlekauff H, Tillisch J, Demer L, Morgan M, Hoffman J, et al. Troponin I Diagnostic Module; 2000.
  11. Misson E, Calzolari C. Elevated cardiac troponin I in some patients with severe congestive heart failure [abstract]. J Mol Cell Cardio 1995;27:A405.
  12. Hollander JE. Department of Emergency Medicine Hospital of the University of Pennsylvania. The Future of Cardiac Biomarkers, New Concepts and Emerging Technology for Emergency Physicians. Philadelphia, Pennsylvania: Emergency Medicine Cardiac Research and Education Group; 2005. p. 4.
  13. Musso P, Vernocchi A, Pasquino M, Crippa A, Ottello B, Panteghini M, et al. Cardiac troponin I and T in unstable angina: Incidence, correlation, kinetics of release and prognostic value. G Ital Cardiol 1996;26:1013-23.
  14. Janorkar S, Koning R, Eltchaninoff H, Andres H, Lavoinne A, Cribier A, et al. Relation between serum cardiac troponin I values and severity of clinical, electrocardiographic and quantitative angiographic features in unstable angina. Indian Heart J 1999;51:31-4.
  15. Benamer H, Steg PG, Benessiano J, Vicaut E, Gaultier CJ, Aubry P, et al. Elevated cardiac troponin I predicts a high-risk angiographic anatomy of the culprit lesion in unstable angina. Am Heart J 1999;137:815-20.
  16. Saadeddin SM, Habbab MA, Siddieg HH, Al Seeni MN, Tahery AB, Dafterdar RM, et al. Evaluation of 6 cardiac troponin assays in patients with acute coronary syndrome. Saudi Med J 2003;24:1092-7.
  17. Cembrowski GS, Cembrowski AR, Kunst AN, Holmes DT, Apple FS. Short term variation important in evaluating goodness of troponin assays for diagnosing myocardial damage. Clin Chem 2014;60:S223.
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