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(Circulation. 2000;102:1216.)
© 2000 American Heart Association, Inc.


Editorial

It’s Time for a Change to a Troponin Standard

Allan S. Jaffe, MD; Jan Ravkilde, MD, DMSc; Robert Roberts, MD; Ulf Naslund, MD, PhD; Fred S. Apple, PhD; Marcello Galvani, MD; Hugo Katus, MD, PhD

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 . . . [Full Text of this Article]




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J. Kamblock, L. Payot, B. Iung, P. Costes, T. Gillet, C. Le Goanvic, P. Lionet, B. Pagis, J. Pasche, C. Roy, et al.
Does rheumatic myocarditis really exists? Systematic study with echocardiography and cardiac troponin I blood levels
Eur. Heart J., May 1, 2003; 24(9): 855 - 862.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
D. A. Morrow, J. A. de Lemos, M. S. Sabatine, and E. M. Antman
The Search for a Biomarker of Cardiac Ischemia
Clin. Chem., April 1, 2003; 49(4): 537 - 539.
[Full Text] [PDF]


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CirculationHome page
C. W. Hamm, E. Giannitsis, and H. A. Katus
Cardiac Troponin Elevations in Patients Without Acute Coronary Syndrome
Circulation, December 3, 2002; 106(23): 2871 - 2872.
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CirculationHome page
F. S. Apple, M. M. Murakami, L. A. Pearce, and C. A. Herzog
Predictive Value of Cardiac Troponin I and T for Subsequent Death in End-Stage Renal Disease
Circulation, December 3, 2002; 106(23): 2941 - 2945.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
M. E. Bertrand, M. L. Simoons, K. A.A. Fox, L. C. Wallentin, C. W. Hamm, E. McFadden, P. J. De Feyter, G. Specchia, and W. Ruzyllo
Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation
Eur. Heart J., December 1, 2002; 23(23): 1809 - 1840.
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ChestHome page
M. Panteghini
Acute Coronary Syndrome: Biochemical Strategies in the Troponin Era
Chest, October 1, 2002; 122(4): 1428 - 1435.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
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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HeartHome page
H Dargie
Myocardial infarction: redefined or reinvented?
Heart, July 1, 2002; 88(1): 1 - 3.
[Full Text] [PDF]


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Clin. Chem.Home page
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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NEJMHome page
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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Clin. Chem.Home page
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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HeartHome page
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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Clin. Chem.Home page
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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ChestHome page
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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Clin. Chem.Home page
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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CirculationHome page
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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JAMAHome page
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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J Am Coll CardiolHome page
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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CirculationHome page
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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Eur Heart J SupplHome page
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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CirculationHome page
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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Eur Heart JHome page
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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J Am Coll CardiolHome page
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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Clin. Chem.Home page
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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Clin. Chem.Home page
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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Clin. Chem.Home page
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]