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 Rørbæk Kamstrup; Morten Dahl; Mustafa Vakur Bor; Ruth Frikke-Schmidt; Niklas Rye Jørgensen; Line Rode; Lene Holmvang; Jesper Kjærgaard; Lia Evi Bang; Julie Forman; Kim Dalhoff; Henning Bundgaard; Kasper Karmark Iversen

doi:10.1016/j.ijcha.2023.101250

Kinetics of cardiac troponin and other biomarkers in patients with ST elevation myocardial infarction

Int J Cardiol Heart Vasc. 2023 Aug 9:48:101250. doi: 10.1016/j.ijcha.2023.101250. eCollection 2023 Oct.

Authors

Jonas Henrik Kristensen^{1

2

3}, Clara Amalie Wistisen Koczulab^{1

2}, Emil Anton Frandsen⁴, Rasmus Bo Hasselbalch^{1

2

3}, Nina Strandkjær^{1

2

3}, Nicoline Jørgensen^{1

2}, Morten Østergaard⁵, Peter Hasse Møller-Sørensen⁵, Jens Christian Nilsson⁵, Shoaib Afzal^{3

6}, Pia Rørbæk Kamstrup⁶, Morten Dahl^{3

7}, Mustafa Vakur Bor⁸, Ruth Frikke-Schmidt⁹, Niklas Rye Jørgensen^{3

9}, Line Rode⁹, Lene Holmvang⁴, Jesper Kjærgaard^{3

4}, Lia Evi Bang⁴, Julie Forman¹⁰, Kim Dalhoff^{3

11}, Henning Bundgaard^{3

4}, Kasper Karmark Iversen^{1

2

3}

Affiliations

¹ Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.
² Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.
³ Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
⁴ Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
⁵ Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
⁶ Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.
⁷ Department of Clinical Biochemistry, Zealand University Hospital - Køge, Lykkebækvej 1, 4600 Køge, Denmark.
⁸ Department of Clinical Biochemistry, University Hospital of Southern Denmark, Finsensgade 35, 6700 Esbjerg, Denmark.
⁹ Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
¹⁰ Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark.
¹¹ Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.

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.

Keywords: Cardiac biomarkers; Cardiac troponin; Cohort study; Coronary artery disease; Kinetics; Myocardial infarction.