Podcast 783: LAD Occlusion & Troponin

<p><strong>Contributor: Jared Scott, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">A study randomized 34 healthy patient to have their left anterior descending artery (LAD) occluded by balloon for 0, 15, 30, or 90 seconds  </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Subsequently,  cardiac troponins (cTns) and Copeptin were measured every 15 minutes for 3 hours, then every 30 minutes for the next 3 hours</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">5 conclusions were drawn:</span></li> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Copeptin is not a useful marker of cardiac ischemia </span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">cTn may be detected after only 30 seconds of ischemia </span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">cTn may be detected in a little as 15 minutes after ischemic event </span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">After only 90 seconds of ischemia, cTn levels met threshold for MI </span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Troponin I is a better marker than troponin T as it rises faster and reaches a higher peak</span></li> </ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Patients very recent or very brief ischemic events may have elevated troponin in the ED</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">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].</span> <em><span style= "font-weight: 400;">Circulation