Emergency Medical Minute23 Touko 2022

Podcast 783: LAD Occlusion & Troponin

Contributor: Jared Scott, MD

Educational Pearls:

A study randomized 34 healthy patient to have their left anterior descending artery (LAD) occluded by balloon for 0, 15, 30, or 90 seconds
Subsequently, cardiac troponins (cTns) and Copeptin were measured every 15 minutes for 3 hours, then every 30 minutes for the next 3 hours
5 conclusions were drawn:

Copeptin is not a useful marker of cardiac ischemia
cTn may be detected after only 30 seconds of ischemia
cTn may be detected in a little as 15 minutes after ischemic event
After only 90 seconds of ischemia, cTn levels met threshold for MI
Troponin I is a better marker than troponin T as it rises faster and reaches a higher peak

Patients very recent or very brief ischemic events may have elevated troponin in the ED

References

Árnadóttir Á, Pedersen S, Bo Hasselbalch R, et al. Temporal Release of High-Sensitivity Cardiac Troponin T and I and Copeptin After Brief Induced Coronary Artery Balloon Occlusion in Humans [published correction appears in Circulation. 2021 Jun 22;143(25):e1116]. Circulation. 2021;143(11):1095-1104. doi:10.1161/CIRCULATIONAHA.120.046574

Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MD, MPH & Erik Verzemnieks, MD

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