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To address this challenge, we developed an electrochemiluminescence (ECL) aptasensor for the detection of cardiac troponin I (cTnI) based on a two\u2010step sequential assembly strategy. DNA nanotetrahedron (NTH)\u2010 assembled aptamers were immobilized onto magnetic beads to form multivalent capture probes for efficient target enrichment via magnetic separation. Meanwhile, a synergistic signal probe was constructed by functionalizing terbium\u2010based metal\u2013organic frameworks (Tb\u2010MOF) loaded with cadmium sulfide quantum dots (CdS QDs) with single\u2010stranded aptamers. Specific recognition of cTnI forms a sandwich\u2010like complex, generating a robust ECL signal for quantitative readout. A systematic comparison between one\u2010step and two\u2010step incubation formats revealed that the latter offers a wider linear range and a lower detection limit (0.04 pg mL\n                    <jats:sup>\u22121<\/jats:sup>\n                    ), owing to its cleaner binding environment and reduced steric interference. Importantly, the platform was successfully applied to quantify target cTnI at cellular, animal, and clinical sample levels, demonstrating the capability for multilevel detection of drug\u2010induced MI. These findings establish a reliable tool for evaluating drug\u2010induced MI with high sensitivity and translational versatility, advancing precision medicine in cancer therapy.\n                  <\/jats:p>","DOI":"10.1002\/adhm.71807","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T03:35:48Z","timestamp":1791344148000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasensitive Electrochemiluminescence Aptasensor With DNA Nanotetrahedron Amplification for Multilevel Detection of cTnI From Cells to Patients"],"prefix":"10.1002","author":[{"given":"Ziteng","family":"Yu","sequence":"first","affiliation":[{"name":"Center For Drug Research and Development, the Second Clinical Medical School (Guangdong Second Provincial General Hospital) Guangdong Pharmaceutical University  Guangzhou Guangdong 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