Clinical Chemistry Link to Randox Laboratories Web Site
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Clinical Chemistry 47: 377-379, 2001;
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Erratum
Right arrow A correction has been published
Right arrow Submit an electronic Letter to
the Editor about this paper
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (73)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Apple, F. S.
Right arrow Articles by Wu, A. H.B.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Apple, F. S.
Right arrow Articles by Wu, A. H.B.
Related Collections
Right arrow Heart Health and the Clinical Laboratory
Right arrow Proteomics and Protein Markers
(Clinical Chemistry. 2001;47:377-379.)
© 2001 American Association for Clinical Chemistry, Inc.

Editorial

Myocardial Infarction Redefined: Role of Cardiac Troponin Testing

Fred S. Apple1,a and Alan H.B. Wu2

1 Department of Laboratory Medicine, and Pathology, University of Minnesota, School of Medicine, Minneapolis, MN 55415

2 Department of Pathology, Hartford Hospital, Hartford, CT 06102
a Address correspondence to this author at: Hennepin County Medical Center, Clinical Laboratories MC 812, 701 Park Ave., Minneapolis MN 55415. Fax 612-904-4229; e-mail fred.apple@co.hennepin.mn.us.

As we move into the new Millennium, "the times they are a changin" regarding the diagnostic criteria used to rule in and rule out acute myocardial infarction (AMI) (1). The purpose of this editorial is to comment on the new cardiology guidelines for the redefinition of AMI and unstable angina, as well as to compare them with previously published laboratory medicine recommendations. Some of the new recommendations made by clinical groups may appear to be in conflict with those published previously by laboratory medicine groups; thus, we document the chronology and evolution of all guidelines on the use of cardiac markers.

Consensus documents recently published by the European Society of Cardiology (ESC), the American College of Cardiology (ACC), and the American Heart Association (AHA) make specific recommendations on the use of biomarkers for the detection of myocardial infarction (MI) (2)(3)(4)(5). The redefined criteria used to classify acute coronary syndrome (ACS) patients presenting with ischemic symptoms as acute, evolving, or recent MI are heavily predicated on an increased serum/plasma cardiac troponin (I or T) concentration (2)(3)(4). Furthermore, in the new ACC/AHA guidelines for management of patients with unstable angina and non-ST-segment elevation MI (NSTEMI), an increased cardiac troponin value establishes the diagnosis of NSTEMI, whereas a normal cardiac troponin value establishes the diagnosis of unstable angina in ACS patients with ischemic discomfort (5).

The new guidelines emphasize the following clinical issues. First, increases of cardiac troponins are indicative of myocardial injury but are not synonymous with MI or an ischemic mechanism of injury. If an ischemic mechanism of injury is unlikely, other etiologies of myocardial injury should be pursued. Second, increases in cardiac troponin likely reflect irreversible rather than reversible injury, although there . . . [Full Text of this Article]


References




The following articles in journals at HighWire Press have cited this article:


Home page
 HeartHome page
R Sharma, D C Gaze, D Pellerin, R L Mehta, H Gregson, C P Streather, P O Collinson, and S J D Brecker
Cardiac structural and functional abnormalities in end stage renal disease patients with elevated cardiac troponin T
Heart, June 1, 2006; 92(6): 804 - 809.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Chem.Home page
F. S. Apple, C. A. Parvin, K. F. Buechler, R. H. Christenson, A. H.B. Wu, and A. S. Jaffe
Validation of the 99th Percentile Cutoff Independent of Assay Imprecision (CV) for Cardiac Troponin Monitoring for Ruling Out Myocardial Infarction
Clin. Chem., November 1, 2005; 51(11): 2198 - 2200.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
M. Panteghini
Role and importance of biochemical markers in clinical cardiology
Eur. Heart J., July 2, 2004; 25(14): 1187 - 1196.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
M. Kemp, J. Donovan, H. Higham, and J. Hooper
Biochemical markers of myocardial injury
Br. J. Anaesth., July 1, 2004; 93(1): 63 - 73.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Chem.Home page
M. Panteghini, F. Pagani, K.-T. J. Yeo, F. S. Apple, R. H. Christenson, F. Dati, J. Mair, J. Ravkilde, and A. H.B. Wu
Evaluation of Imprecision for Cardiac Troponin Assays at Low-Range Concentrations
Clin. Chem., February 1, 2004; 50(2): 327 - 332.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Chem.Home page
J. C. Lin, F. S. Apple, M. M. Murakami, and R. V. Luepker
Rates of Positive Cardiac Troponin I and Creatine Kinase MB Mass among Patients Hospitalized for Suspected Acute Coronary Syndromes
Clin. Chem., February 1, 2004; 50(2): 333 - 338.
[Abstract] [Full Text] [PDF]

Home page
 Toxicol SciHome page
J. T. MacGregor
The Future of Regulatory Toxicology: Impact of the Biotechnology Revolution
Toxicol. Sci., October 1, 2003; 75(2): 236 - 248.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Chem.Home page
F. S. Apple, H. E. Quist, P. J. Doyle, A. P. Otto, and M. M. Murakami
Plasma 99th Percentile Reference Limits for Cardiac Troponin and Creatine Kinase MB Mass for Use with European Society of Cardiology/American College of Cardiology Consensus Recommendations
Clin. Chem., August 1, 2003; 49(8): 1331 - 1336.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Chem.Home page
D. A. Morrow, N. Rifai, M. S. Sabatine, S. Ayanian, S. A. Murphy, J. A. de Lemos, E. Braunwald, and C. P. Cannon
Evaluation of the AccuTnI Cardiac Troponin I Assay for Risk Assessment in Acute Coronary Syndromes
Clin. Chem., August 1, 2003; 49(8): 1396 - 1398.
[Full Text] [PDF]

Home page
 Clin. Chem.Home page
S. Eriksson, M. Junikka, P. Laitinen, K. Majamaa-Voltti, H. Alfthan, and K. Pettersson
Negative Interference in Cardiac Troponin I Immunoassays from a Frequently Occurring Serum and Plasma Component
Clin. Chem., July 1, 2003; 49(7): 1095 - 1104.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Chem.Home page
R. Ziebig, A. Lun, B. Hocher, F. Priem, C. Altermann, G. Asmus, H. Kern, R. Krause, B. Lorenz, R. Mobes, et al.
Renal Elimination of Troponin T and Troponin I
Clin. Chem., July 1, 2003; 49(7): 1191 - 1193.
[Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
M. Beciani, A. Tedesco, A. Violante, S. Cipriani, M. Azzarito, A. Sturniolo, and G. Splendiani
Cardiac troponin I (2nd generation assay) in chronic haemodialysis patients: prevalence and prognostic value
Nephrol. Dial. Transplant., May 1, 2003; 18(5): 942 - 946.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Chem.Home page
M. Herrmann, J. Scharhag, M. Miclea, A. Urhausen, W. Herrmann, and W. Kindermann
Post-Race Kinetics of Cardiac Troponin T and I and N-Terminal Pro-Brain Natriuretic Peptide in Marathon Runners
Clin. Chem., May 1, 2003; 49(5): 831 - 834.
[Full Text] [PDF]

Home page
 Clin. Chem.Home page
Y. E.C. Taes, N. H. Lameire, M. L. De Buyzere, A. Shoja, G. De Backer, and J. R. Delanghe
Exercise-induced Myocardial Ischemia Is Accompanied by Increased Serum Creatine Concentrations
Clin. Chem., April 1, 2003; 49(4): 684 - 686.
[Full Text] [PDF]

Home page
 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]

Home page
 Clin. Chem.Home page
J. R. Tate, T. Badrick, G. Koumantakis, J. M. Potter, and P. E. Hickman
Reporting of Cardiac Troponin Concentrations
Clin. Chem., November 1, 2002; 48(11): 2077 - 2080.
[Full Text] [PDF]

Home page
 Clin. Chem.Home page
A. H.B. Wu and F. S. Apple
Drs. Wu and Apple respond:
Clin. Chem., November 1, 2002; 48(11): 2080 - 2082.
[Full Text] [PDF]

Home page
 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]

Home page
 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]

Home page
 Clin. Chem.Home page
V. Scharnhorst, H. L. Vader, and F. van der Graaf
Characteristics of the Cardiac Troponin I Assay on the Immulite 2000 Analyzer
Clin. Chem., September 1, 2002; 48(9): 1626 - 1627.
[Full Text] [PDF]

Home page
 Clin. Chem.Home page
D. Peetz, G. Hafner, and K. J. Lackner
Analytical Characteristics of the AxSYM Cardiac Troponin I and Creatine Kinase MB Assays
Clin. Chem., July 1, 2002; 48(7): 1110 - 1111.
[Full Text] [PDF]

Home page
 Clin. Chem.Home page
M. Panteghini
Performance of Today's Cardiac Troponin Assays and Tomorrow's
Clin. Chem., June 1, 2002; 48(6): 809 - 810.
[Full Text] [PDF]

Home page
 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]

Home page
 Clin. Chem.Home page
A. Cerutti, L. Corsini, R. Finotto, and C. Perazzi
Comparison of Cardiac Troponin I in Serum and Heparin Plasma with the Dimension RxL Assay
Clin. Chem., May 1, 2002; 48(5): 790 - 791.
[Full Text] [PDF]

Home page
 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]

Home page
 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]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2001 by the American Association for Clinical Chemistry.