Kinetics of cardiac troponin and other biomarkers in patients with ST elevation myocardial infarction
Jonas Henrik Kristensen, Clara Amalie Wistisen Koczulab, Emil Anton Frandsen, Rasmus Bo Hasselbalch, Nina Strandkjær, Nicoline Jørgensen, Morten Østergaard, Peter Hasse Møller-Sørensen, Jens Christian Nilsson, Shoaib Afzal, Pia R. Kamstrup, Morten Dahl, Mustafa Vakur Bor, Ruth Frikke‐Schmidt, Niklas Rye Jørgensen, Line Rode, Lene Holmvang, Jesper Kjærgaard, Lia E. Bang, Julie Lyng Forman, Kim Dalhoff, Henning Bundgaard, Kasper Iversen
Abstract
Objective: To examine changes in concentration, time-to-peak and the ensuing half-life of cardiac biomarkers in patients with myocardial infarction. Methods: Blood sampling was performed every third hour within 24 h 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. Results: A total of 36 patients completed blood sampling (median age 60 years, IQR 56.4-66.5 years; seven women, 19.4%). Hs-cTnI measured by the Vitros assay was the first hs-cTn to peak at 9.1 h (95%-CI 6.2-10.1) after PCI and 11.7 h (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 7.6 h for myoglobin (CI 6.8-8.6) to 17.8 h for CK (CI 6.8-8.6). For hs-cTn assays the median T½ ranged from 12.4 h for the Vista hs-cTnI assay (95%-CI 11.0-14.1 h) to 17.3 h for the Elecsys hs-cTnT (95%-CI 14.9-20.8 h). Conclusions: 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.