Advertisement

Mitigation of the clinical significance of spurious elevations of cardiac troponin I in settings of coronary ischemia using serial testing of multiple cardiac markers

      Abstract

      The ability to differentiate between true positives, false positives, and sporadically elevated cardiac troponin levels has grown in importance as cardiac troponins assume an increasingly dominant role in the diagnosis of coronary syndromes. In a population sample of 1,000 patients who presented consecutively to a large urban hospital emergency room, 50 of 112 patients who had elevated troponin levels (>0.6 ng/ml) during evaluation for myocardial injury were subsequently found to have had an isolated, spurious elevation of cardiac troponin, and not a diagnosed myocardial infarction. Logistic regression analysis shows that by hierarchically analyzing electrocardiographic changes with concurrent creating kinase-MB and myoglobin levels at the time of the troponin elevation, one may predict with 91% accuracy whether the troponin elevation is actually indicative of a myocardial infarction in a patient. Spurious troponin elevations may be a common occurrence, and if not detected, may result in an increased number of falsely diagnosed myocardial infarctions.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Jesse R.L
        Impact of the measurement of troponin on the triage, prognosis, and treatment of patients with chest pain.
        Clin Chim Acta. 1999; 284: 213-221
        • Tanasijevic M.J
        • Antman E.M
        Diagnostic performance of cardiac troponin I in suspected acute myocardial infarction.
        Am Heart J. 1999; 137: 203-206
      1. Wright SA, Goldhaber SZ. Nonspecific elevation of troponin I. ACC Curr J Rev 1998; Nov-Dec:29–31.

        • Wu A
        • Apple F.S
        • Gibler W.B
        • Jesse R.L
        • Warshaw M.M
        • Valdes R
        National Academy of Clinical Biochemistry Standards of Laboratory Practive.
        Clin Chem. 1999; 45: 1104-1121
        • Wu A.H.B
        • Feng Y.J
        • Moore R
        • Apple F.S
        • McPherson Ph
        • Buechler K.F
        Characterization of cardiac troponin subunit release into serum after acute myocardial infarction and comparison of assays for troponin T and I.
        Clin Chem. 1998; 44: 1198-1208
        • Ng S.M
        • Krishnaswamy P
        • Morrisey R
        • Maisel A
        A critical pathway for chest pain patients allows accurate triaging within 90 minutes of presentation to the emergency room (abstr).
        J Am Coll Cardiol. 2000; 35: 379A
        • Adams III, J.E
        • Miracle V.A
        Cardiac biomarkers.
        Am J Crit Care. 1998; 7: 418-425
        • Olatidoye A.G
        • Wu A.H.B
        • Feng Y.J
        • Waters D
        Prognostic role of troponin T versus troponin I in unstable angina pectoris for cardiac events with meta-analysis comparing published studies.
        Am J Cardiol. 1998; 81: 1405-1410
        • Lindahl B
        • Venge P
        • Wallentin L
        Relation between troponin T and the risk of subsequent cardiac events in unstable coronary artery disease.
        Circulation. 1996; 93: 1651-1657
        • Lefkovits J
        • Plow E.F
        • Topol E.J
        Platelet glycoprotein II/B/IIIA receptors in cardiovascular medicine.
        N Engl J Med. 1995; 332: 1553-1559
        • Wu A.H
        • Ford L
        Release of cardiac troponin in acute coronary syndromes.
        Clin Chim Acta. 1999; 284: 161-174
        • Baxter S.M
        • Brogan Jr, G.X
        • Archerlraod Jr, F.P
        Rapid evaluation by assay of cardiac troponin T (RECTT).
        Acad Emerg Med. 1997; 4: 1018-1024
        • Wright S.A
        • Sawyer D.B
        • Sacks D.B
        • Chyu S
        • Goldhaber S.Z
        Elevation of troponin I levels in patients without evidence of myocardial injury.
        JAMA. 1997; 278: 2144-2145
        • Roppolo L.P
        • Fitzgerald R
        • Dillow J
        • Ziegler T
        • Rice M
        • Maisel A
        A comparison of troponin T and troponin I as predictors of cardiac events in patients undergoing chronic dialysis at a Veteran’s Hospital.
        J Am Coll Cardiol. 1999; 34: 448-454
        • Missov E
        • Calzolari C
        • Pau B
        Circulating cardiac troponin I in severe congestive heart failure.
        Circulation. 1997; 96: 2953-2958
        • Del Carlo C.H
        • O’Conner C.M
        Cardiac troponins in congestive heart failure.
        Am Heart J. 1999; 138: 646-653
        • Despres N
        • Grant A.M
        Antibody interference in thyroid assays.
        Clin Chem. 1998; 44: 440-453
        • Ward G
        • McKinnon L
        • Badrick T
        • Hickman P.E
        Heterophilic antibodies remain a problem for the immunoassay laboratory.
        Am J Clin Pathol. 1997; 108: 417-421
      2. Kricka LJ. Human anti-animal antibody interferences in immunological assays. Clini Chem 1999;45:7:942–946.

        • Shi Q
        • Ling M
        • Zhang X
        • Zhang M
        • Kadijevic L
        • Liu S
        • Laurine J.P
        Degradation of cardiac troponin I in serum complicates comparisons of cardiac troponin I assays.
        Clin Chem. 1999; 45: 1018-1025
        • Christenson R.H
        • Apple F.S
        • Morganj D.L
        • Alonsozana G.L
        • Mascotti K
        • Olsen M
        Cardiac troponin I measurement with the ACCESS immunoassay system.
        Clin Chem. 1998; 44: 52-60
      3. Ng SM, Krishnaswamy P, Morissey R, Clopton P, Fitzgerald R, Maisel AS. Ninety minute accelerated critical pathway for chest pain evaluation. European Society of Cardiology XXI Congress Proceedings, 1999:398–403.

        • Maisel A.S
        • Templin K
        A prospective study of cardiac troponin I and myoglobin as an adjunct in the early diagnosis of acute myocardial infarction.
        Clin Cardiol. 2000; 23: 915-920
        • de Winter R.J
        • Koster R.W
        • Sturk A
        • Sanders G.T
        Value of myoglobin, troponin T, and CK-MB mass in ruling out an acute myocardial infarction in the emergency room.
        Circulation. 1995; 92: 3401-3407
        • Maisel A.S
        Cardiac markers in the assessment of patients with acute coronary syndromes.
        Top Emerg Med. 1998; 20: 14-22
        • Kost G.J
        • Kirk J.D
        • Omand K
        A strategy for the use of cardiac injury markers (troponin I and T, creatine kinase-MB mass and isoforms, and myoglobin) in the diagnosis of acute myocardial infarction.
        Arch Pathol Lab Med. 1998; 122: 245-251