Coronary disease & ACSDiagnostic or prognostic study
The cTnI/cTnT Ratio in Myocardial Injury
- Diagnostic accuracy study
- 3 prospective clinical studies
- centrally adjudicated diagnoses
- internal and external validation
- 4 experimental cardiomyocyte models
Authors' conclusion
The cTnI/cTnT ratio distinguishes acute necrotic from chronic/non-necrotic myocardial injury in clinical and experimental studies, and improves type 1 vs type 2 AMI discrimination, offering potential diagnostic value and challenging the interchangeability of cTnI and cTnT.
Study context
- Population
- Participants of 3 prospective clinical studies with centrally adjudicated diagnoses; hs-cTnI (Architect) and hs-cTnT (Elecsys) measured
- Participants
- 9,704 participants · 3 cohorts
- Comparison
- cTnI/cTnT ratio across no known, chronic and acute cardiac disease
Performance
As reported in the abstract
cTnI/cTnT ratio
Acute cardiac disease
2.06
95% CI 1.89–2.26
Chronic cardiac disease
0.66
95% CI 0.60–0.72
No known cardiac disease
0.50
95% CI 0.43–0.59
Further findings
| Outcome | AUC (95% CI) | P value |
|---|---|---|
| Discrimination of type 1 vs type 2 acute MI · vs AUC 0.70 (95% CI: 0.67-0.73) | 0.73 (0.70–0.76) | P < 0.01 |
Experimental cardiomyocyte models
- Mild nonlethal injury: cTnT-dominant release (ratio ∼0.5)
- Lethal injury: cTnI-dominant release (ratio >1)
Validation
- Consistent across alternative hs-cTnI assays and external validation cohorts
Original publication
The cTnI/cTnT Ratio in Myocardial Injury. J Am Coll Cardiol. Published 25 February 2026. doi:10.1016/j.jacc.2025.12.078
Summarised from the published abstract; every number is checked against it