The Atellica-assessed cTnI assay demonstrated a significantly higher relative pre-to-post-procedural concentration increase compared to Architect-cTnI (39.6-fold vs 20.5-fold; p=0.0036).
Observational (n=158)
Does the Atellica-IM-cTnI assay show different sensitivity compared to Architect-cTnI and Elecsys-cTnT assays in detecting very acute myocardial injury following pulmonary vein isolation in patients with atrial fibrillation?
The Atellica hs-cTnI assay demonstrates enhanced sensitivity for very acute myocardial injury compared to other assays, potentially improving the differentiation of acute from chronic myocardial injury.
Absolute Event Rate: 39.6% vs 20.5%
p-value: p=0.0036
Abstract Background High-sensitivity cardiac troponin (hs-cTn) assays indicating myocardial injury are critical to identify myocardial injury, but their use to differentiate between acute and chronic myocardial injury is limited. This study aimed to assess the differential utility of three hs-cTn assays, targeting different troponin epitopes (proximal and/or central), to detect myocardial injury in a clinical model of acute myocardial injury by left-atrial ablation. Methods Pre- and post-procedural serum samples were prospectively collected from 158 patients with atrial fibrillation undergoing pulmonary vein isolation (PVI) in a standardised setting, with pre-procedural samples obtained after venous puncture and post-procedural samples obtained just before sheath removal within a maximum of one hour after the last left-atrial ablation. cTn-concentrations were measured using the high-sensitive Architect-cTnI-, Atellica-IM-cTnI-, and Elecsys-cTnT-assays. cTnI/T-concentrations and -ratios were compared, also to established ESC rule-in-thresholds for myocardial infarction. Results The Atellica-assessed cTnI showed a doubled relative pre-to-post-procedural concentration-increase compared to Architect-cTnI (39.6-fold versus 20.5-fold; p=0.0036) and Elecsys-cTnI (4.7-fold, p0.001). Median post-procedural Architect-cTnI-to-Elecsys-cTnT-ratio was 1.7 1.2,2.4 and median post-procedural Atellica-cTnI-to-Elecsys-cTnT-ratio was 5.3 3.6,7.3 (Figure 1). The Atellica-hs-cTnI/T-ratio had a 2.5 95%-CI 1.1,5.2 relative increase, while the Architect-cTnI-to-Elecsys-cTnT-ratio showed a 6.9 95%-CI 2.3,11.8 relative increase (p0.0001) (Figure 1). In 124/158 (78%) of procedures at least one and in 76/158 (48%) all three post-procedurally measured cTn-levels were above the assay-specific rule-in threshold (Figure 2). In the majority (76/124; 61%) of these procedures, all three post-procedural cTn-levels were rule-in positive, in 20% only 1/3 assays and in 19% of procedures 2/3 assays. Significant interactions with age and CKD (Coefficient -0.3 (95% CI -0.129;-0.006), p=0.039) were identified. Age had only a small negative (Coefficient -0.1 (95% CI 0.9;42.2), p=0.033) but CKD a strong, positive predictive effect (Coefficient 21.5 (95% CI -0.6;-0.02), p=0.041) for higher post-procedural troponin ratios. Conclusions The Atellica-assay demonstrated enhanced sensitivity for very acute myocardial injury, likely via its additional recognition of the proximally located cTnI epitope. This suggests its potential to improve differentiation of acute from chronic myocardial injury, warranting further investigation to confirm its clinical utility in that setting.Figure 1 Figure 2
Obergassel et al. (2025) conducted an observational in Atrial fibrillation (n=158). Atellica-IM-cTnI assay vs. Architect-cTnI and Elecsys-cTnT assays was evaluated on Relative pre-to-post-procedural concentration-increase (p=0.0036). The Atellica-assessed cTnI assay demonstrated a significantly higher relative pre-to-post-procedural concentration increase compared to Architect-cTnI (39.6-fold vs 20.5-fold; p=0.0036).