The utility of troponin measurement to detect myocardial infarction: review of the current findings

Myocardial infarction (MI) is defined by the presence of myocardial necrosis in combination with clinical evidence of myocardial ischemia. Cardiac troponins are regulatory proteins within the myocardium that are released into the circulation when damage to the myocyte has occurred. Therefore, serum troponin is an exquisitely sensitive marker of myocardial injury and is necessary for establishing the diagnosis of MI. High-sensitivity troponin assays are improving the diagnostic accuracy and rapid detection of myocardial infarction. The early identification of MI is vital for the institution of anti-thrombotic therapy to limit myocardial damage and preserve cardiac function. Troponin has both diagnostic and prognostic significance in the setting of acute coronary syndrome (ACS). Increased troponin levels in the absence of ACS should prompt an evaluation for an alternative, non-thrombotic mechanism of troponin elevation and direct management at the underlying cause. This review describes the role of troponin in the evaluation of patients with suspected myocardial infarction.

[1]  A. Jaffe,et al.  Diagnosis of perioperative myocardial infarction with measurement of cardiac troponin I. , 1994, The New England journal of medicine.

[2]  J. P. Higgins,et al.  Elevation of cardiac troponin I indicates more than myocardial ischemia. , 2003, Clinical and investigative medicine. Medecine clinique et experimentale.

[3]  J. Boura,et al.  Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction : a quantitative review of 23 randomised trials , 2022 .

[4]  A. Wu.  Increased troponin in patients with sepsis and septic shock: myocardial necrosis or reversible myocardial depression? , 2001, Intensive Care Medicine.

[5]  A. Jaffe,et al.  National Academy of Clinical Biochemistry and IFCC Committee for Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines: analytical issues for biochemical markers of acute coronary syndromes. , 2007, Clinical chemistry.

[6]  A. Jaffe,et al.  High-sensitivity cardiac troponin: hype, help, and reality. , 2010, Clinical chemistry.

[7]  Fred S Apple,et al.  National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical characteristics and utilization of biochemical markers in acute coronary syndromes. , 2007, Circulation.

[8]  S. Slørdahl,et al.  [Myocardial injury in acute stroke assessed by troponin I]. , 2001, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[9]  A. Remppis,et al.  Intracellular compartmentation of cardiac troponin T and its release kinetics in patients with reperfused and nonreperfused myocardial infarction. , 1991, The American journal of cardiology.

[10]  W. Gerhardt,et al.  Can troponin T replace CK MBmass as "gold standard" for acute myocardial infarction ("AMI")? , 1999, Scandinavian journal of clinical and laboratory investigation. Supplementum.

[11]  Fred S Apple,et al.  Predictive Value of Cardiac Troponin I and T for Subsequent Death in End-Stage Renal Disease , 2002, Circulation.

[12]  T. Fehr,et al.  Elevation of troponin I in sepsis and septic shock , 2001, Intensive Care Medicine.

[13]  E. Missov,et al.  Clinical insights on the use of highly sensitive cardiac troponin assays. , 1999, Clinica chimica acta; international journal of clinical chemistry.

[14]  J. Ioannidis,et al.  Accuracy of biomarkers to diagnose acute cardiac ischemia in the emergency department: a meta-analysis. , 2001, Annals of emergency medicine.

[15]  B. Sobel,et al.  Ediortial: Isoenzymes of creatine phosphokinase and diagnosis of myocardial infarction. , 1973, Annals of internal medicine.

[16]  S. Homma,et al.  Editorial comment--myocardial damage in patients with subarachnoid hemorrhage. , 2004, Stroke.

[17]  Fred S Apple,et al.  Biomarkers in acute cardiac disease: the present and the future. , 2006, Journal of the American College of Cardiology.

[18]  D. Atsma,et al.  Usefulness of peak troponin-T to predict infarct size and long-term outcome in patients with first acute myocardial infarction after primary percutaneous coronary intervention. , 2009, The American journal of cardiology.

[19]  A. Jaffe.  Chasing troponin: how low can you go if you can see the rise? , 2006, Journal of the American College of Cardiology.

[20]  B. Lindahl,et al.  Diagnostic value of serial measurement of cardiac markers in patients with chest pain: limited value of adding myoglobin to troponin I for exclusion of myocardial infarction. , 2004, American heart journal.

[21]  Jack H. Ladenson,et al.  Cardiac Troponin I A Marker With High Specificity for Cardiac Injury , 1993, Circulation.

[22]  A. Jaffe,et al.  The clinical need for high-sensitivity cardiac troponin assays for acute coronary syndromes and the role for serial testing. , 2008, American heart journal.

[23]  Hugo A. Katus,et al.  Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. , 2000, European heart journal.

[24]  N. Weissman,et al.  Troponin-I elevation in patients with increased left ventricular mass. , 2003, The American journal of cardiology.

[25]  J. Tate.  Troponin revisited 2008: assay performance , 2008, Clinical chemistry and laboratory medicine.

[26]  J. Georges,et al.  Time course of troponin I, myoglobulin, and cardiac enzyme release after electrical cardioversion. , 1996, The American journal of cardiology.

[27]  J. Ornato,et al.  ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patie , 2007, Journal of the American College of Cardiology.

[28]  M. Abrahamowicz,et al.  Myocardial injury in critically ill patients: relation to increased cardiac troponin I and hospital mortality. , 2005, Chest.

[29]  F. Apple,et al.  Role of monitoring changes in sensitive cardiac troponin I assay results for early diagnosis of myocardial infarction and prediction of risk of adverse events. , 2009, Clinical chemistry.

[30]  Y. Pinto,et al.  Impaired Renal Clearance Explains Elevated Troponin T Fragments in Hemodialysis Patients , 2004, Circulation.

[31]  A. Jaffe,et al.  Improved detection of cardiac contusion with cardiac troponin I. , 1996, American heart journal.

[32]  B. Drew,et al.  Predictors of Neurocardiogenic Injury After Subarachnoid Hemorrhage , 2004, Stroke.

[33]  A. Jaffe,et al.  Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates. , 1997, Circulation.

[34]  H. Joller-jemelka,et al.  Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes. , 2003, Journal of the American College of Cardiology.

[35]  M. Noble,et al.  Prognostic significance of admission troponin T concentrations in patients with myocardial infarction. , 1996, Circulation.

[36]  C. Cannon,et al.  Elevations in Troponin T and I Are Associated With Abnormal Tissue Level Perfusion: A TACTICS-TIMI 18 Substudy , 2002, Circulation.

[37]  G. Agnelli,et al.  Prognostic Value of Troponins in Acute Pulmonary Embolism: A Meta-Analysis , 2007, Circulation.

[38]  E. Antman,et al.  Myoglobin, creatine-kinase-MB and cardiac troponin-I 60-minute ratios predict infarct-related artery patency after thrombolysis for acute myocardial infarction: results from the Thrombolysis in Myocardial Infarction study (TIMI) 10B. , 1999, Journal of the American College of Cardiology.

[39]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2009, Circulation.

[40]  A. Jaffe,et al.  It's time for a change to a troponin standard. , 2000, Circulation.

[41]  J. Januzzi,et al.  Clinical Applications of Highly Sensitive Troponin Assays , 2010, Cardiology in review.

[42]  R. Gibbons,et al.  Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. , 1998, JAMA.

[43]  L. Wallentin,et al.  Clinical performance of three cardiac troponin assays in patients with unstable coronary artery disease (a FRISC II substudy). , 2002, The American journal of cardiology.

[44]  W. Peacock,et al.  Cardiac troponins in renal insufficiency: review and clinical implications. , 2002, Journal of the American College of Cardiology.

[45]  Christopher E. Buller,et al.  2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. , 2008, Journal of the American College of Cardiology.

[46]  L. Wallentin,et al.  Persistent Cardiac Troponin I Elevation in Stabilized Patients After an Episode of Acute Coronary Syndrome Predicts Long-Term Mortality , 2007, Circulation.

[47]  A. Jaffe,et al.  Myocardial injury in critically ill patients : a frequently unrecognized complication , 1995 .

[48]  A. Jaffe.  The clinical impact of the universal diagnosis of myocardial infarction , 2008, Clinical chemistry and laboratory medicine.

[49]  Joseph P Ornato,et al.  Implication of different cardiac troponin I levels for clinical outcomes and prognosis of acute chest pain patients. , 2004, Journal of the American College of Cardiology.

[50]  S. Yanturali,et al.  Can elevated troponin I levels predict complicated clinical course and inhospital mortality in patients with acute pulmonary embolism? , 2006, The American journal of emergency medicine.

[51]  A. Go,et al.  The prognostic value of troponin in patients with non-ST elevation acute coronary syndromes: a meta-analysis. , 2001, Journal of the American College of Cardiology.

[52]  P. Collinson,et al.  Cardiac structural and functional abnormalities in end stage renal disease patients with elevated cardiac troponin T , 2005, Heart.

[53]  Tobias Reichlin,et al.  Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. , 2009, The New England journal of medicine.

[54]  Eorge,et al.  CARDIAC-SPECIFIC TROPONIN I LEVELS TO PREDICT THE RISK OF MORTALITY IN PATIENTS WITH ACUTE CORONARY SYNDROMES , 2000 .

[55]  M. Pfeffer,et al.  A sensitive cardiac troponin T assay in stable coronary artery disease. , 2009, The New England journal of medicine.

[56]  M. Panteghini,et al.  The Sensitivity of Cardiac Markers: an Evidence-based Approach , 1999, Clinical chemistry and laboratory medicine.

[57]  G. Fonarow,et al.  Cardiac Troponin I Is Associated With Impaired Hemodynamics, Progressive Left Ventricular Dysfunction, and Increased Mortality Rates in Advanced Heart Failure , 2003, Circulation.

[58]  G. Wells,et al.  Cardiac troponin T predicts long-term outcomes in hemodialysis patients. , 2001, Clinical chemistry.

[59]  Michael Marber,et al.  Sensitive troponin I assay in early diagnosis of acute myocardial infarction , 2010 .

[60]  W. Aronow,et al.  Prevalence of increased cardiac troponin I levels in patients with and without acute pulmonary embolism and relation of increased cardiac troponin I levels with in-hospital mortality in patients with acute pulmonary embolism. , 2004, The American journal of cardiology.

[61]  F. Apple,et al.  Cardiac troponin and creatine kinase MB monitoring during in-hospital myocardial reinfarction. , 2005, Clinical chemistry.

[62]  M. Sabatine,et al.  Detection of myocardial injury in patients with unstable angina using a novel nanoparticle cardiac troponin I assay: observations from the PROTECT-TIMI 30 Trial. , 2009, American heart journal.

[63]  G. Lamas,et al.  ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients wi , 2004, Journal of the American College of Cardiology.

[64]  E. Antman,et al.  Early noninvasive detection of failed epicardial reperfusion after fibrinolytic therapy. , 2001, The American journal of cardiology.

[65]  A. Jeremias,et al.  Narrative Review: Alternative Causes for Elevated Cardiac Troponin Levels when Acute Coronary Syndromes Are Excluded , 2005, Annals of Internal Medicine.

[66]  C. Vassanelli,et al.  [Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban]. , 2001, Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology.

[67]  J. Parrillo.  Pathogenetic mechanisms of septic shock. , 1993, The New England journal of medicine.

[68]  Zachary D. Tebb.  Prognostic Value of Troponins in Acute Pulmonary Embolism: A Meta-Analysis , 2007 .

[69]  E. Antman,et al.  Detection of unsuspected myocardial necrosis by rapid bedside assay for cardiac troponin T. , 1997, American heart journal.

[70]  R. Collins,et al.  Early diagnostic efficiency of cardiac troponin I and Troponin T for acute myocardial infarction. , 1997, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[71]  A. Wu,et al.  Biochemical differences between cTnT and cTnI and their significance for diagnosis of acute coronary syndromes. , 1998, European heart journal.

[72]  A. Jaffe,et al.  Biochemical Markers of Myocardial Injury Is MB Creatine Kinase the Choice for the 1990s? , 1993, Circulation.

[73]  E. Braunwald,et al.  Ability of minor elevations of troponins I and T to predict benefit from an early invasive strategy in patients with unstable angina and non-ST elevation myocardial infarction: results from a randomized trial. , 2001, JAMA.

[74]  C. Herzog,et al.  Cardiac troponin T and C-reactive protein for predicting prognosis, coronary atherosclerosis, and cardiomyopathy in patients undergoing long-term hemodialysis. , 2003, JAMA.

[75]  Ric,et al.  CARDIAC TROPONIN T LEVELS FOR RISK STRATIFICATION IN ACUTE MYOCARDIAL ISCHEMIA , 2000 .

[76]  L. Lind,et al.  Will the universal definition of myocardial infarction criteria result in an overdiagnosis of myocardial infarction? , 2009, The American journal of cardiology.

[77]  R. Lazzara,et al.  Analysis of Troponin I Levels After Spontaneous Implantable Cardioverter Defibrillator Shocks , 2002, Journal of cardiovascular electrophysiology.

[78]  Fred S Apple,et al.  Universal definition of myocardial infarction. , 2007, Journal of the American College of Cardiology.

[79]  F. Harrell,et al.  Cardiac troponin T levels for risk stratification in acute myocardial ischemia. GUSTO IIA Investigators. , 1996, The New England journal of medicine.