Role of Monitoring Changes in Sensitive Cardiac Troponin I Assay Results for Early Diagnosis of Myocardial Infarction and Prediction of Risk of Adverse Events

BACKGROUND: We sought to determine the diagnostic accuracy of the cardiac troponin I (cTnI) VITROS (R) Troponin I-ES assay for early detection Of acute myocardial infarction (AM]) and for risk prediction of adverse events in patients with symptoms of acute coronary syndrome (ACS). METHODS: cTnI was measured on admission and approximately 6 h postadmission in 381 patients. The 99th percentile cTnI concentration (0.034 mu g/L) and change [delta (delta)] between admission and follow-up concentrations were evaluated in diagnostic sensitivity and specificity calculations. Risk of cardiac event or death within 60 days was evaluated by Cox proportional hazards regression. RESULTS: AMI occurred in 52 patients. Diagnostic sensitivities (95% Cl) of admission and follow-up cTnIs for AM] were 69% (55%-81%) and 94% (84%-99%), respectively. The corresponding specificities (95% Cl) were 78% (73%-82%) and 81% (77%-85%), and ROC curve areas were 0.82 vs 0.96 (P < 0.001). Deltas between admission and follow-up cTnI > 30% had a sensitivity of 75% (95% Cl 61%-86%) and a specificity of 91% (95% Cl 87%-94%). During follow-up, I cardiac death, 2 noncardiac deaths, 52 AMIs) 6 coronary artery bypass grafts, and 43 percutanous coronary interventions occurred in 62 patients. A delta cTnI > 30%, when added to either initial cTnI > 0.034 mu g/L or follow-up cTnI > 0.034 mu g/L, improved risk stratification for cardiac event or death (P < 0.001). CONCLUSIONS: Admission cTnI measured by the VITROS ES assay is a sensitive biomarker for detection of AMI. Utilizing > 30% cTnI delta in addition to either the baseline or follow-up concentration improved both specificity and risk assessment in patients presenting with symptoms of ACS. (C) 2009 American Association for Clinical Chemistry