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

To examine changes in concentration, time-to-peak and the ensuing half-life of cardiac biomarkers in patients with myocardial infarction. 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. 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). 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.

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The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [HB received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Amgen, Sanofi, BMS, MSD. HB owns stock or stock options in Novo Nordic. PRK reported a grant from Gangsted Fonden outside the present work. PRK reported consulting fees from Novartis and Silence Therapeutics. PRK reported Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Physicians’ Academy for Cardiovascular Education, Novartis and PCSK9 Forum. RFS reported grants or contracts outside the present work from Lundbeck Foundation, Innovation Fund Denmark, The Danish Heart Foundation, Sygeforsikringen Denmark Research Fund, Leducq Foundation. RFS reported payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novo Nordic. RFS reported being a steering committee member of the Copenhagen General Population Study, Steering committee member of the Copenhagen Baby Heart Study, and Deputy Head, Department of Clinical Medicine, University of Copenhagen. JK reports a grant or contract from Novo Nordic outside the present work. LH reported personal payment or honoraria for lectures from Boeringer Ingelheim and payment or honoraria to her institution for lectures from Bayer. LH reported receiving support for travel from Abbott to her Institution. MVB reported receiving honoraria for a lecture from Bristol-Myers.].