Direct comparison of high-sensitivity-cardiac troponin I vs. T for the early diagnosis of acute myocardial infarction.
OBJECTIVE
It is unknown whether cardiac troponin (cTn) I or cTnT is the preferred biomarker in the early diagnosis of acute myocardial infarction without ST segment elevation (NSTEMI).


RESULTS
In a prospective multicentre study, we measured cTnI and cTnT using clinically available high-sensitivity assays (hs-cTnI Abbott and hs-cTnT Roche) and compared their diagnostic and prognostic accuracies in consecutive patients presenting to the emergency department with acute chest pain. The final diagnosis was adjudicated by two independent cardiologists using all information pertaining to the individual patient. The mean follow-up was 24 months. Among 2226 consecutive patients, 18% had an adjudicated final diagnosis of NSTEMI. Diagnostic accuracy at presentation as quantified by the area under the receiver-operating-characteristics curve (AUC) for NSTEMI was very high and similar for hs-cTnI [AUC: 0.93, 95% confidence interval (CI) 0.92-0.94] and hs-cTnT (0.94, 95% CI: 0.92-0.94) P = 0.62. In early presenters (<3 h since chest pain onset) hs-cTnI showed a higher diagnostic accuracy (AUC: 0.92, 95% CI: 0.89-0.94) when compared with hs-cTnT AUC (0.89, 95% CI: 0.86-0.91) (P = 0.019), while hs-cTnT was superior in late presenters [AUC hs-cTnT 0.96 (95% CI: 0.94-0.96)  vs. hs-cTnI 0.94 (95% CI: 0.93-0.95); P = 0.007]. The prognostic accuracy for all-cause mortality, quantified by AUC, was significantly higher for hs-cTnT (AUC: 0.80; 95% CI: 0.78-0.82) when compared with hs-cTnI (AUC: 0.75; 95% CI: 0.73-0.77; P < 0.001).


CONCLUSIONS
Both hs-cTnI and hs-cTnT provided high diagnostic and prognostic accuracy. The direct comparison revealed small but potentially important differences that might help to further improve the clinical use of hs-cTn.
Department of Cardiology, University Hospital Basel, Basel, Switzerland Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar - Institut Municipal D'Investigació Mèdica, Barcelona, Spain.
Maria
M
Rubini Gimenez
Department of Cardiology, University Hospital Basel, Basel, Switzerland Universitäres Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
Raphael
R
Twerenbold
Department of Cardiology, University Hospital Basel, Basel, Switzerland Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Tobias
T
Reichlin
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Karin
K
Wildi
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Philip
P
Haaf
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Miriam
M
Schaefer
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Christa
C
Zellweger
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Berit
B
Moehring
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Fabio
F
Stallone
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Seoung Mann
SM
Sou
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Mira
M
Mueller
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Kris
K
Denhaerynck
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Tamina
T
Mosimann
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Miriam
M
Reiter
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Bernadette
B
Meller
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Michael
M
Freese
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Claudia
C
Stelzig
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Irina
I
Klimmeck
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Janine
J
Voegele
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Beate
B
Hartmann
Laboratory Medicine, University Hospital Basel, Basel, Switzerland.
Katharina
K
Rentsch
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Stefan
S
Osswald
Department of Cardiology, University Hospital Basel, Basel, Switzerland christian.mueller@usb.ch.
Christian
C
Mueller
D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000378:metabolism; D042241:Early Diagnosis; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000378:metabolism*; D020107:Troponin T / Q000378:metabolism*
D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T
Acute myocardial infarction; High-sensitive cardiac troponin