Kinetics of cardiac troponin and other biomarkers in patients with ST elevation myocardial infarction.

Abstract

To examine changes in concentration, time-to-peak and the ensuing half-life of cardiac biomarkers in patients with myocardial infarction. Blood sampling was performed every third hour within 24h after percutaneous coronary intervention (PCI) on a cohort of patients with ST elevation myocardial infarction. Cardiac troponin (cTn) was measured by the Dimension Vista, Vitros, Atellica, and Alinity high-sensitivity (hs) cTnI assays, and the Elecsys hs-cTnT assay. Further, creatine kinase (CK), myoglobin, creatine kinase MB (CKMB) and other biomarkers were analyzed. A total of 36 patients completed blood sampling (median age 60years, IQR 56.4-66.5years; seven women, 19.4%). Hs-cTnI measured by the Vitros assay was the first hs-cTn to peak at 9.1h (95%-CI 6.2-10.1) after PCI and 11.7h (95%-CI 10.4-14.8) after symptoms onset. There were no notable differences between hs-cTn assays in regard to time-to-peak. Also, Vitros hs-cTnI reached the highest median ratio of concentration to upper reference level of nearly 2,000. The median half-life from peak concentration ranged from 7.6h for myoglobin (CI 6.8-8.6) to 17.8h for CK (CI 6.8-8.6). For hs-cTn assays the median T½ ranged from 12.4h for the Vista hs-cTnI assay (95%-CI 11.0-14.1h) to 17.3h for the Elecsys hs-cTnT (95%-CI 14.9-20.8h). This study updates knowledge on the kinetics of cardiac biomarkers in current clinical use. There was no notable difference in trajectories, time-to-peak or half-life between hs-cTn assays.