Abstract

DIAGNOSTIC EFFICACY OF CARDIAC TROPONIN-T IN ACUTE MYOCARDIAL INFARCTION PATIENTS ADMITTED IN INTENSIVE CARDIAC CARE UNIT

Author(s): Tapan Debnath1, Sankar Roy2, Abhik Chakraborty3, Partha Sarathi Paul4, Mohan Chandra Mondal5

INTRODUCTION
Myocardial infarction is a common and severe manifestation of ischaemic heart disease (IHD). Acute myocardial infarction (AMI) is the result of death of heart muscle cells following either from a prolonged or severe ischaemia. The World Health Organisation emphasises IHD as our "Modern Epidemic" and AMI as common cause of sudden death.
AIM
The present study has been undertaken with the aim to assess the role of cardiac Troponin-T in early diagnosis of AMI and to evaluate its positive roles over CK-MB and LDH enzyme assays. The study also aims to find out the role of cardiac Troponin-T test, where ECG changes are nondiagnostic and inconclusive for AMI.
MATERIAL & METHOD
One hundred cases of provisionally diagnosed AMI, who were admitted during June 2012 to July 2015 in ICC Unit of TMC & Dr. BRAM Teaching Hospital, formed the subjects for the study. Those patients reported 2 to 10 hours after onset of chest pain were included in this study.
Patients reported beyond 10 hours after onset of chest pain of AMI cases and patients having chest pain of non-AMI causes are excluded from the study.
The provisional diagnosis of AMI was done on the basis of the history, chest pain, clinical findings and ECG changes. Trop-T test (Troponin-T sensitive rapid test by Muller Bardoff, et al, 1991) as well as CK-MB (creatine kinase-MB isoenzyme- assays were performed immediately for each and every patient. Trop-T test was repeated in some selective cases where the early changes were insignificant and the results were compared with those of CK-MB, at different period of the disease onset.
RESULTS
The rapid cardiac Troponin-T test (CTn-T) has 100% specificity for AMI whereas CK-MB and LDH have specificities of 80% and 60% respectively. The CTn-T has diagnostic efficiency of 92% for AMI but ECG has only 69% sensitivity and 80% specificity. The overall diagnostic efficacy of cardiac Troponin-T is higher than that of CK-MB, LDH and ECG (94% versus 92%, 91 % and 72% respectively). So, cardiac Troponin-T test done between 4 to 10 hours following onset of the disease is an excellent marker for evaluating chest pain of AMI or ACS.
CONCLUSION
It is therefore, concluded that cardiac Troponin-T test done between 4 to 10 hours following onset of the disease is an excellent marker for evaluating chest pain of AMI or ACS.

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