The prognostic significance of troponin I and troponin T
G B Green1, D J Li, E S Bessman
1Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA. ggreen@gwgate1.jhmi.jhu.edu
Insights
Early cardiac biomarker testing in the emergency department (ED) can identify patients at high risk for adverse events. While cardiac troponin I (cTn-I) and cardiac troponin T (cTn-T) showed similar prognostic abilities, creatine kinase-MB (CK-MB) demonstrated stronger predictive power for adverse events.
Area of Science:
- Cardiology
- Emergency Medicine
- Biomarker Research
Background:
- Early identification of myocardial ischemia in emergency departments (EDs) is crucial for patient outcomes.
- Cardiac troponin I (cTn-I), cardiac troponin T (cTn-T), and creatine kinase-MB (CK-MB) are commonly used biomarkers.
- Comparing the prognostic value of these early markers is essential for clinical decision-making.
Purpose of the Study:
- To compare the prognostic abilities of single-sample measurements of cTn-I, cTn-T, and CK-MB.
- To evaluate their effectiveness in predicting adverse events (AEs) in patients with suspected myocardial ischemia.
- To determine optimal early diagnostic strategies in the ED.
Main Methods:
- Prospective data collection from 401 patients with suspected myocardial ischemia across two urban EDs.
- Utilized identity-unlinked techniques for serologic and clinical data.
- Calculated relative risks (RRs) and predictive values for AEs within 14 days post-enrollment.
Main Results:
- All three biomarkers (cTn-I, cTn-T, CK-MB) were significant predictors of AEs.
- CK-MB showed a stronger predictive ability for AEs compared to cTn-I (p=0.01) and cTn-T (p=0.001).
- While sensitivities were low, specificities for predicting AEs were high across all markers.
Conclusions:
- No significant difference in prognostic ability was observed between cTn-I and cTn-T.
- Routine testing of both CK-MB and a troponin assay may enhance early identification of high-risk patients.
- This combined approach can facilitate targeted care and consideration of aggressive therapies.
Objectives:
To determine and compare the prognostic abilities of early, single-sample measurements of cardiac troponin I (cTn-I), cardiac troponin T (cTn-T), and creatine kinase-MB (CK-MB) among ED patients with possible myocardial ischemia.
Methods:
Prospective collection of clinical and serologic data using an identity-unlinked technique from patients with possible myocardial ischemia at 2 urban EDs. Outcome data concerning the occurrence of adverse events (AEs) during the 14 days after enrollment were used to calculate and compare the relative risks (RRs) and predictive values (with 95% confidence intervals) of the 3 markers for predicting AEs.
Results:
Among the 401 study patients, 105 AEs occurred in 67 patients. cTn-I, cTn-T, and CK-MB were all significantly predictive of AEs, with RRs of 3.87 (2.39, 6.26), 3.03 (1.92, 4.79), and 6.45 (4.74, 8.77), respectively. For prediction of AEs, sensitivity for each of the 3 markers was low (cTn-I = 15.38, cTn-T = 24.62, CK-MB = 15.38), while specificity was high (cTn-I = 97.62, cTn-T = 93.15, CK-MB = 99.70). No significant difference in predictive ability was found between cTn-I and cTn-T. However, a positive CK-MB result was a stronger predictor of AEs than either cTn-I (p = 0.01) or cTn-T (p = 0.001).
Conclusions:
No significant difference in predictive abilities was found between cTn-I and cTn-T. However, routine testing for both CK-MB and either of the troponins may optimize early identification of high-risk patients so they may be targeted for a higher level of care and consideration of more aggressive therapies.
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