(Circulation. 2000;102:1216.)
© 2000 American Heart Association, Inc.
Editorial |
It’s Time for a Change to a Troponin Standard
From the Mayo Clinic, Rochester, Minn (A.S.J.); Aalborg University Hospital, Aalborg, Denmark (J.R.); Baylor College of Medicine, Houston, Tex (R.R.); Norrland University Hospital, Umea, Sweden (U.N.); Hennepin County Medical Center and the University of Minnesota, Minneapolis (F.S.A.); Ospedale G.B. Morgagni and Fondazione Cardiologica Sacco, Forlì, Italy (M.G.); and Universitat zu Lubeck, Lubeck, Germany (H.K.).
Correspondence Allan S. Jaffe, MD, 16th Floor, Mayo Building, 200 First Street SW, Rochester, MN 55905. E-mail Jaffe.Allan@mayo.edu
Key Words: Editorials • troponin • myocardial infarction • coronary disease
Recently, the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) convened a conference to discuss refinements in the diagnosis of acute myocardial infarction. The panel on biochemistry considered issues related to the use of marker proteins. We were guided predominantly by the science of the area. We were also cognizant of the impact that changes in the standards would have on epidemiology, clinical trials, education of physicians, and patient care. Our recommendations will be incorporated, with the recommendations of the other panels, into a position paper for the ESC and the ACC. However, the members of the biochemistry group decided to express the opinions we felt were important in this area independently. Our thinking does not represent the position of the ESC, the ACC, or of the conjoint task force.
Many modifications of the original World Health Organization criteria
for acute myocardial infarction1 have been accepted and
incorporated into the ESC/ACC criteria; some deletions have also
occurred. Until recently, most markers were detected using enzymatic
activity; detection of the protein concentration now is preferred.
Thus, it is more appropriate to refer to molecules released into the
circulation as a consequence of cardiac injury as biochemical
diagnostic markers or biomarkers. In this editorial, we
emphasize issues related to the biochemical diagnosis of acute
myocardial infarction. New and improved plasma biomarkers (troponins)
with better sensitivity and specificity will be emphasized in
preference to markers such as total creatine kinase (CK), CK-MB,
lactate dehydrogenase, and aspartate aminotransferase. Rapid assays
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F. S. Apple, M. M. Murakami, R. L. Jesse, M. A. Levitt, A. K. Berger, L. A. Pearce, and P. Collinson Near-Bedside Whole-Blood Cardiac Troponin I Assay for Risk Assessment of Patients with Acute Coronary Syndromes Clin. Chem., October 1, 2002; 48(10): 1784 - 1787. [Full Text] [PDF]
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H Dargie Myocardial infarction: redefined or reinvented? Heart, July 1, 2002; 88(1): 1 - 3. [Full Text] [PDF]
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F. S. Apple, H. E. Quist, A. P. Otto, W. E. Mathews, and M. M. Murakami Release Characteristics of Cardiac Biomarkers and Ischemia-modified Albumin as Measured by the Albumin Cobalt-binding Test after a Marathon Race Clin. Chem., July 1, 2002; 48(7): 1097 - 1100. [Full Text] [PDF]
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 E. M. Antman Decision Making with Cardiac Troponin Tests N. Engl. J. Med., June 27, 2002; 346(26): 2079 - 2082. [Full Text] [PDF]
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D. Uettwiller-Geiger, A. H.B. Wu, F. S. Apple, A. W. Jevans, P. Venge, M. D. Olson, C. Darte, D. L. Woodrum, S. Roberts, and S. Chan Multicenter Evaluation of an Automated Assay for Troponin I Clin. Chem., June 1, 2002; 48(6): 869 - 876. [Abstract] [Full Text] [PDF]
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J Herrmann, C von Birgelen, M Haude, L Volbracht, N Malyar, H Eggebrecht, T F M Konorza, D Baumgart, and R Erbel Prognostic implication of cardiac troponin T increase following stent implantation Heart, June 1, 2002; 87(6): 549 - 553. [Abstract] [Full Text] [PDF]
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D. A. Colantonio, W. Pickett, R. J. Brison, C. E. Collier, and J. E. Van Eyk Detection of Cardiac Troponin I Early after Onset of Chest Pain in Six Patients Clin. Chem., April 1, 2002; 48(4): 668 - 671. [Full Text] [PDF]
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L. Holmvang, B. Jurlander, C. Rasmussen, J. J. Thiis, P. Grande, and P. Clemmensen Use of Biochemical Markers of Infarction for Diagnosing Perioperative Myocardial Infarction and Early Graft Occlusion After Coronary Artery Bypass Surgery Chest, January 1, 2002; 121(1): 103 - 111. [Abstract] [Full Text] [PDF]
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G. P. Armstrong, A. N. Barker, H. Patel, and H. H. Hart Reference Interval for Troponin I on the ACS:Centaur Assay: A Recommendation Based on the Recent Redefinition of Myocardial Infarction Clin. Chem., January 1, 2002; 48(1): 198 - 199. [Full Text] [PDF]
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F. S. Apple, A. S. Jaffe, L. K. Newby, A. L. Kaplan, R. H. Tuttle, S. E. McNulty, E. M. Ohman, A. B. Storrow, W. B. Gibler, J. L. Garvey, et al. Bedside Multimarker Testing for Risk Stratification in Chest Pain Units: The Chest Pain Evaluation by Creatine Kinase-MB, Myoglobin, and Troponin I (CHECKMATE) Study Response Circulation, November 27, 2001; 104 (22): e125 - e126. [Full Text] [PDF]
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 D. A. Morrow, C. P. Cannon, N. Rifai, M. J. Frey, R. Vicari, N. Lakkis, D. H. Robertson, D. A. Hille, P. T. DeLucca, P. M. DiBattiste, 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 JAMA, November 21, 2001; 286(19): 2405 - 2412. [Abstract] [Full Text] [PDF]
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A. S. Jaffe Testing the wrong hypothesis: the failure to recognize the limitations of troponin assays J. Am. Coll. Cardiol., October 1, 2001; 38(4): 999 - 1001. [Full Text] [PDF]
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C. W. Hamm Cardiac Biomarkers for Rapid Evaluation of Chest Pain Circulation, September 25, 2001; 104(13): 1454 - 1456. [Full Text] [PDF]
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E.M. Antman, R. Corbalan, K. Huber, and A.S. Jaffe Issues in early risk stratification for UA/NSTEMI Eur. Heart J. Suppl., August 1, 2001; 3(suppl_J): J6 - J14. [Abstract] [PDF]
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G. Heusch Nitroglycerin and Delayed Preconditioning in Humans : Yet Another New Mechanism for an Old Drug? Circulation, June 19, 2001; 103(24): 2876 - 2878. [Full Text] [PDF]
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H. Tunstall-Pedoe Comment on the ESC/ACC redefinition of myocardial infarcation by a consensus dissenter Eur. Heart J., April 1, 2001; 22(7): 613 - 615. [PDF]
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H. Tunstall-Pedoe Redefinition of myocardial infarction by a consensus dissenter J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1472 - 1473. [Full Text] [PDF]
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G. K. Davis, R. Labugger, J. E. Van Eyk, and F. S. Apple Cardiac Troponin T Is Not Detected in Western Blots of Diseased Renal Tissue Clin. Chem., April 1, 2001; 47(4): 782 - 783. [Full Text] [PDF]
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F. S. Apple and A. H.B. Wu Myocardial Infarction Redefined: Role of Cardiac Troponin Testing Clin. Chem., March 1, 2001; 47(3): 377 - 379. [Full Text] [PDF]
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F. S. Apple, M. Murakami, M. Panteghini, R. H. Christenson, F. Dati, J. Mair, and A. H.B. Wu International Survey on the Use of Cardiac Markers Clin. Chem., March 1, 2001; 47(3): 587 - 588. [Full Text] [PDF]
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