INTRODUCTION AND OBJECTIVES: Release kinetics of high-sensitivity cardiac troponin (hs-cTn) T and I in patients with acute myocardial infarction (AMI) are incompletely understood. We aimed to assess whether hs-cTnT/I release in early AMI is near linear. METHODS: In a prospective diagnostic multicenter study the acute release of hs-cTnT and hs-cTnI within 1 and 2hours from presentation to the emergency department was quantified using 3 hs-cTnT/I assays in patients with suspected AMI. The primary endpoint was correlation between hs-cTn changes from presentation to 1 hour vs changes from presentation to 2hours, among all AMI patients and different prespecified subgroups. The final diagnosis was adjudicated by 2 independent cardiologists, based on serial hs-cTnT from the serial study blood samples and additional locally measured hs-cTn values. RESULTS: Among 2437 patients with complete hs-cTnT data, AMI was the adjudicated diagnosis in 376 patients (15%). For hs-cTnT, the correlation coefficient between 0- to 1-hour change and 0- to 2 hour change was 0.931 (95%CI, 0.916-0.944), P <.001. Similar findings were obtained with hs-cTnI (Architect) with correlation coefficients between 0- to 1-hour change and 0- to 2 hour change of 0.969 and hs-cTnI (Centaur) of 0.934 (P <.001 for both). Findings were consistent among type 1 and type 2 AMI and in the subgroup of patients presenting very early after chest pain onset. CONCLUSIONS: Patients presenting with early AMI showed a near linear release of hs-cTnT and hs-cTnI. This near linearity provides the pathophysiological basis for rapid diagnostic algorithms using 0- to 1-hour changes as surrogates for 0- to 2 hour or 0- to 3 hour changes. Registered at ClinicalTrials.gov (Identifier: NCT00470587).

2nd Department of Cardiology Medical University of Silesia Zabrze Poland

Blood Transfusion Centre Swiss Red Cross Basel Switzerland and Department of Hematology University Hospital Basel Basel Switzerland

Department of Cardiology and Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland

Department of Cardiology and Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland; Critical Care Research Institute the Prince Charles Hospital Brisbane and University of Queensland Brisbane Australia

Department of Cardiology and Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland; Department of Cardiology Heart Center Leipzig Leipzig Germany

Department of Cardiology and Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland; Department of Cardiology University of Illinois at Chicago Chicago United States

Department of Cardiology and Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland; Department of Department Inselspital Bern University Hospital University of Bern Bern Switzerland

Department of Cardiology and Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland; Department of Heart Surgery University Hospital Basel Basel Switzerland

Department of Cardiology and Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland; Department of Internal Medicine University Hospital Basel Basel Switzerland

Department of Cardiology and Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland; Emergency Department University Hospital Basel Basel Switzerland

Department of Cardiology University Hospital Brno Brno Czech Republic and Medical Faculty Masaryk University Brno Czech Republic

Emergency Department University Hospital Zurich Zurich Switzerland

Laboratory Medicine University Hospital Basel Basel Switzerland

Servicio de Urgencias Hospital Clínic Barcelona Spain

Servicio de Urgencias Hospital Clínico San Carlos Madrid Spain

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ClinicalTrials.gov
NCT00470587