Diagnosis of Acute Myocardial Infarction

Doctors in a specialist cardiology clinic in Heidelberg, Germany, have shown that the Elecsys® Troponin T high sensitive (hs) assay from Roche helps to identify more patients with acute myocardial infarction (AMI)
earlier, compared to less sensitive 4th generation cardiac troponin assays. This high sensitive assay for cardiac Troponin T (cTnT) offers excellent precision (<10% CV) at the 99th percentile reference limit of a healthy population, making it the first commercially available Troponin T assay to meet the recent ESC/ACCF/AHA/WHF recommendations for the diagnosis of myocardial infarction (MI).

“The improved performance of the high sensitive assay means that not only can we identify MI at an earlier opportunity, but we can also now identify more patients with MI (amongst those with symptoms of acute coronary syndrome (ACS)) than we could with the less sensitive assay,” commented Dr Evangelos Giannitsis from the Cardiology Clinic at the University Hospital, Heidelberg.

The ESC/ACCF/AHA/WHF redefinition of MI requires an increase or decrease of cardiac troponin to be demonstrated in patients with symptoms of ACS, with at least one of the concentrations greater than the 99th percentile of the reference population. Dr Giannitsis and his team found that, when used in this way, the Elecsys Troponin T hs assay increased the number of non- ST segment myocardial infarction (NSTEMI) diagnoses and enabled earlier detection of evolving NSTEMI3.

“The test has 100% tissue specificity and so it is excellent for the identification of patients with sub-clinical disease manifestations, which may also have an elevated cTnT. Interpretation of the high sensitive result should therefore consider the clinical presentation and the kinetics of the cTnT elevation. This is very helpful for distinguishing between chronic and acute disease. If there is a very rapid elevation or decline in cTnT between two measurements then this implies an acute condition such as AMI. If there is a more stable elevation, then it is more likely to be a chronic condition.”

The cardiology clinic in Heidelberg now uses the Elecsys Troponin T hs assay routinely to test patients presenting with ACS. The new Elecsys Troponin T hs assay is suitable for use on all cobas® and Modular Analytics serum work areas.