[Early evaluation of results from systemic thrombolysis in acute myocardial infarct: the value of troponin I].
Cardiac troponin-T (Tn-T) and troponin I (Tn-I) isoforms are sensitive and specific tests for the diagnosis of acute myocardial infarction. Information is scanty regarding the ability of these markers to discriminate patients with or without reperfusion early after thrombolytic treatment. To this purpose, 64 patients (mean age 63.7 +/- 7.5 years) with acute myocardial infarction, treated with recombinant tissue-type plasminogen activator within 6 hours from the onset of symptoms, were enrolled in the study. Tn-I was determined by immunofluorescency (Dade, Stratus II) at the beginning of thrombolysis, 30 min after therapy (120 min after starting) and every 6 hours in the first 2 days of acute myocardial infarction. At the same intervals, samples for Tn-T (immunoenzymatic methods ELISA), creatin phosphokinase (CK) and CK-MB (biochemical method) were collected. Normal subjects showed values of Tn-I and Tn-T steadily lower than 0.2 micrograms/l. To evaluate reperfusion, for each parameter the time to peak concentration and the ratio (delta) between the levels of the marker 30 min after thrombolysis vs basal, were considered. Coronary angiography was performed in all patients within 4 days, in 48 patients (Group 1) reperfusion (TIMI grade 2-3) of the involved vessel was reached, in 16 (Group 2) reperfusion was absent (TIMI 0-1). In Group 1, at 30 min after the end of thrombolysis, an increase of cardiac Tn-1 of at least 5.5 times compared to baseline, was observed; In-T, CK and CK-MB reached concentrations at least 7-fold greater than basal ones; in Group 2 patients, no significant variation of concentration of all markers was found. Therefore, in order to discriminate between reperfused and non reperfused patients, cut-off values of the ratio delta of 5.5 for Tn-I and of 7 for Tn-T were chosen. By this method, sensitivity for detection of reperfusion was 95, 80, 54 and 56%; specifically 100, 89, 79 and 82%, respectively. In Group 1 Tn-I peaked earlier than other parameters (9.2 +/- 1.7 vs 12.4 +/- 2.4 hours for Tn-T, p< 0.04 and vs 13 +/- 1.7 hours for CK and CK-MB, p<0.03); the peak of each marker showed the following values of sensitivity and specificity for reperfusion: 86 and 89% for Tn-I, 79 and 82% for Tn-T, 78 and 80% for CK, 83 and 80% for CK-MB. The time to peak of troponins, CK and CK-MB is a sensitive index of reperfusion after thrombolytic therapy in acute myocardial infarction; the delta Tn-I is the earliest marker of reperfusion allowing the assessment of efficacy of treatment within 2 hours after its beginning.
Giraldi
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Istituto di Cardiologia, Universit degli Studi, Centro di Studio per le Ricerche Cardiovascolari del CNR, Centro Centro Cardiologico-Fondzione Monzino, IRCCS, Milano.
Grazi
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Guazzi
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D000328:Adult; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000473:pathology; D015428:Myocardial Reperfusion Injury / Q000503:physiopathology; D019210:Troponin I / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D019210:Troponin I