Dagnostic and prognostic value of cardiac troponin I measurement with qualitative and quantitative methods in acute yocardial infarction and unstable angina

Introduction: The insufficient specificity and sensitivity of clinical manifestations, ECG and common cardiac biomarkers, such as CK, CK-MB and LDH, caused problems in diagnosis of acute myocardoial infraction (AMI) and make some patients not be diagnosed and completely treated. To improve the management of patients with acute coronary syndrome (ACS) and reduce hospitalization, rapid and bed side measurements of new cardiac biomarkers are interested and investigated. Materials and Methods: In this study, 208 patients with ACS were involved. The clinical findings, ECG and level of cardiac enzymes including LDH, CK-MB, total CK, quantitative and qualitative cardiac troponin-I (CTN-I) were recorded on admission (time 0),12 and 24 hours there after. Complications of each patient were recorded during hospitalization. Results: There was no typical angina pectoris (11 %) no typical diagnostic ECG changes (41 %) (3% were completely normal) no increasing in total CK (12%) and CK-MB (8%) in patients with AMI so, common cardiac biomarkers leads to fault in diagnosis of some of these patients, while CTNI was an ideal diagnostic biomarker, because of its high sensitivity (100%) and specificity (99%). There was a significant relation between increasing CTNI and cardiac complication, specifically, arrhythmia in AMI cases that indicate the hight risk patients. Also CTNI was a marker of reperfusion. In 13% of unstable angina cases, CTN-I slightly increased, indicating the high risk group. The sensitivity and specificity of quantitative measurement of CTN-I was slightly higher than qualitative method. Conclusion: CTN-I was more cost effective with high diagnostic and prognostic value, as compared with the other biomarkers so routinely quantitative or qualitative measurement of CTN-I, on admission (time 0),12 and 24 hours thereafter is recommended in ACS patients, instead of other biomarkers.