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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