{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:14:50Z","timestamp":1792012490241,"version":"4.4.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Mindray"},{"DOI":"10.13039\/100017245","name":"Hennepin Healthcare Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017245","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We determined whether circulating cardiac troponin I\u2013cardiac troponin T\u2013troponin C (ITC) complex containing long-form cardiac troponin T (long-T ITC) complex and ratios of high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) could differentiate myocardial infarction (MI) from chronic and acute non-MI myocardial injuries in patients with suspected acute coronary syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We measured long-T ITC complex, hs-cTnI, and hs-cTnT (Mindray) at 0- and 2-h in consecutive patients enrolled in the Mindray hs-cTnI Assay Analytical and Clinical Evaluation for the Diagnosis and RIsk Assessment of Myocardial InfarctIon (MERITnI) trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 882 subjects studied (median 3.0\u2005h presentation), 47 had acute MI (5.3%), 116 had acute non-MI myocardial injury, and 90 had chronic myocardial injury. At 0 and 2\u2005h, areas under the curve (AUC) significantly differentiated acute MI from chronic myocardial injury for long-T ITC complex (0.72 and 0.81, respectively; P = 0.0082) but not acute non-MI myocardial injury (AUC, 0.65 and 0.69, respectively; P = 0.23). 0 and 2\u2005h AUCs for long-T ITC complex\/hs-cTnT and hs-cTnI\/hs-cTnT ratios also significantly differentiated acute MI from chronic myocardial injury (AUC, 0.79 and 0.86, respectively) and acute non-MI myocardial injury (AUC, 0.68 and 0.71, respectively). There was no biomarker concentration or ratio value discrimination between type 1 and type 2 MIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long-T ITC concentrations and long-T ITC complex\/hs-cTnT and hs-cTnI\/hs-cTnT ratios may clinically assist in differentiating acute MI from non-MI myocardial injuries when evaluating patients with suspected acute coronary syndrome.<\/jats:p>\n                    <jats:p>ClinicalTrials.gov Registration Number: NCT05853042.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/clinchem\/hvag098","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T11:54:56Z","timestamp":1784807696000},"source":"Crossref","is-referenced-by-count":1,"title":["Distinguishing Acute Myocardial Infarction from Other Forms of Cardiac Injury with the Cardiac Troponin Long-T ITC Complex and High-Sensitivity Troponin I and T in Patients with Suspected Acute Coronary Syndrome: MERITnI Substudy"],"prefix":"10.1093","author":[{"given":"Fred S","family":"Apple","sequence":"first","affiliation":[{"name":"Hennepin Healthcare Research Institute , Minneapolis, MN ,","place":["United States"]},{"name":"Department of Laboratory Medicine & Pathology, Hennepin Healthcare , Minneapolis, MN ,","place":["United States"]},{"name":"Department of Laboratory Medicine & Pathology, University of Minnesota School of Medicine , Minneapolis, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin G","family":"Buda","sequence":"additional","affiliation":[{"name":"Division of Pulmonary & Critical Care Medicine, Mayo Clinic , Rochester, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barret P","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hennepin Healthcare , Minneapolis, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4800-2972","authenticated-orcid":false,"given":"Yader","family":"Sandoval","sequence":"additional","affiliation":[{"name":"Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN ,","place":["United States"]},{"name":"Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation , Minneapolis, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen W","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hennepin Healthcare , Minneapolis, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6513-7356","authenticated-orcid":false,"given":"Hannah M","family":"Brown","sequence":"additional","affiliation":[{"name":"Hennepin Healthcare Research Institute , Minneapolis, MN ,","place":["United States"]},{"name":"Department of Laboratory Medicine & Pathology, Hennepin Healthcare , Minneapolis, MN ,","place":["United States"]},{"name":"Department of Laboratory Medicine & Pathology, University of Minnesota School of Medicine , Minneapolis, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8645-2478","authenticated-orcid":false,"given":"Joshua R","family":"Miller","sequence":"additional","affiliation":[{"name":"Hennepin Healthcare Research Institute , Minneapolis, MN ,","place":["United States"]},{"name":"Department of Laboratory Medicine & Pathology, Hennepin Healthcare , Minneapolis, MN ,","place":["United States"]},{"name":"Department of Laboratory Medicine & Pathology, University of Minnesota School of Medicine , Minneapolis, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Sexter","sequence":"additional","affiliation":[{"name":"Hennepin Healthcare Research Institute , Minneapolis, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Schulz","sequence":"additional","affiliation":[{"name":"Hennepin Healthcare Research Institute , Minneapolis, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan S","family":"Jaffe","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mayo Clinic , Rochester, MN ,","place":["United States"]},{"name":"Department of Laboratory Medicine and Pathology, Mayo Clinic , Rochester, MN ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"2026082005383387300_hvag098-B1","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1093\/clinchem\/hvaa263","article-title":"Sex-specific kinetics of high-sensitivity cardiac troponin I and T following symptom onset and early presentation in non-ST-segment elevation myocardial infarction","volume":"67","author":"Sandoval","year":"2021","journal-title":"Clin Chem"},{"key":"2026082005383387300_hvag098-B2","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.cca.2020.02.009","article-title":"Early kinetic profiles of troponin I and T measured by high sensitivity assays in patients with myocardial infarction","volume":"505","author":"Pickering","year":"2020","journal-title":"Clin Chim Acta"},{"key":"2026082005383387300_hvag098-B3","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1161\/CIRCULATIONAHA.120.046574","article-title":"Temporal release of high-sensitivity cardiac troponin T and I and copeptin after brief induced coronary artery balloon occlusion in humans","volume":"143","author":"Arnadottir","year":"2021","journal-title":"Circulation"},{"key":"2026082005383387300_hvag098-B4","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1093\/clinchem\/hvaa281","article-title":"Myocardial injury and the release of troponins I and T in the blood of patients","volume":"67","author":"Katrukha","year":"2021","journal-title":"Clin Chem"},{"key":"2026082005383387300_hvag098-B5","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1515\/cclm-2025-0385","article-title":"Comparison of the cardiac troponin I-cardiac troponin T-troponin C complex and cardiac troponin I and T in distinguishing myocardial infarction using a single sample at presentation","volume":"64","author":"Li","year":"2026","journal-title":"Clin Chem Lab Med"},{"key":"2026082005383387300_hvag098-B6","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1093\/clinchem\/hvae182","article-title":"Design and analytical evaluation of novel cardiac troponin assays targeting multiple forms of the cardiac troponin I\u2014 cardiac troponin T\u2014troponin C complex and fragmentation forms","volume":"71","author":"Li","year":"2025","journal-title":"Clin Chem"},{"key":"2026082005383387300_hvag098-B7","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1093\/clinchem\/hvae200","article-title":"Characterization of cardiac troponin fragment composition reveals potential for differentiating etiologies of myocardial injury","volume":"71","author":"Li","year":"2025","journal-title":"Clin Chem"},{"key":"2026082005383387300_hvag098-B8","doi-asserted-by":"crossref","first-page":"e0276645","DOI":"10.1371\/journal.pone.0276645","article-title":"Diagnostic and prognostic performance of the ratio between high sensitivity cardiac troponin I and troponin T in patients with chest pain","volume":"17","author":"Eggers","year":"2022","journal-title":"PLoS One"},{"key":"2026082005383387300_hvag098-B9","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1016\/j.jacc.2025.12.078","article-title":"The cTnI\/cTnT ratio in myocardial injury: a multicohort and experimental synthesis","volume":"87","author":"Zimmerman","year":"2026","journal-title":"J Am Coll Cardiol"},{"key":"2026082005383387300_hvag098-B10","first-page":"355","article-title":"Differences between cardiac troponin I vs. T according to the duration of myocardial ischemia","volume":"12","author":"Espinosa","year":"2023","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"2026082005383387300_hvag098-B11","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1093\/clinchem\/hvaf016","article-title":"Cardiac troponin I and T ratio of cardiovascular or non-cardiovascular events in a general population","volume":"71","author":"de Baker","year":"2025","journal-title":"Clin Chem"},{"key":"2026082005383387300_hvag098-B12","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1161\/CIRCULATIONAHA.121.056208","article-title":"Exercise-induced cardiac troponin elevations: from underlying mechanisms to clinical relevance","volume":"144","author":"Airaksinen","year":"2021","journal-title":"Circulation"},{"key":"2026082005383387300_hvag098-B13","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1093\/clinchem\/hvaa231","article-title":"Cardiac troponin composition characterization after non-ST-elevation myocardial infarction: relation with culprit artery, ischemic time window, and severity of injury","volume":"67","author":"Damen","year":"2021","journal-title":"Clin Chem"},{"key":"2026082005383387300_hvag098-B14","doi-asserted-by":"crossref","first-page":"e012602","DOI":"10.1161\/JAHA.119.012602","article-title":"Multi-site coronary vein sampling study on cardiac troponin T degradation in non\u2013ST-segment\u2013elevation myocardial infarction: toward a more specific cardiac troponin T assay","volume":"8","author":"Damen","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2026082005383387300_hvag098-B15","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1134\/S0006297913130063","article-title":"Human cardiac troponin complex. 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the start of a new era-perhaps?","volume":"70","author":"Jaffe","year":"2024","journal-title":"Clin Chem"},{"key":"2026082005383387300_hvag098-B20","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1093\/clinchem\/hvae075","article-title":"Highly sensitive immunoassay for long forms of cardiac troponin T using upconversion luminescence","volume":"70","author":"Salonnen","year":"2024","journal-title":"Clin Chem"},{"key":"2026082005383387300_hvag098-B21","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1373\/clinchem.2018.301127","article-title":"Full-size and partially truncated cardiac troponin complexes in the blood of patients with acute myocardial infarction","volume":"65","author":"Vylegzhanina","year":"2019","journal-title":"Clin Chem"},{"key":"2026082005383387300_hvag098-B22","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1373\/clinchem.2017.286211","article-title":"Full-size cardiac troponin I and its proteolytic fragments in blood of patients with acute myocardial infarction: antibody selection for assay development","volume":"64","author":"Katrukha","year":"2018","journal-title":"Clin Chem"},{"key":"2026082005383387300_hvag098-B23","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1373\/clinchem.2016.261644","article-title":"Cardiac troponin T: smaller molecules in patients with end-stage renal disease than after onset of acute myocardial infarction","volume":"63","author":"Mingels","year":"2017","journal-title":"Clin Chem"},{"key":"2026082005383387300_hvag098-B24","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1373\/jalm.2018.027144","article-title":"Cardiac troponin T: only small molecules in recreational runners after marathon completion","volume":"3","author":"Vroemen","year":"2019","journal-title":"J Appl Lab Med"},{"key":"2026082005383387300_hvag098-B25","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1515\/cclm-2023-0529","article-title":"Evaluation of the analytical and clinical performance of a new high-sensitivity cardiac troponin I assay: hs-cTnI (CLIA) assay","volume":"62","author":"Li","year":"2024","journal-title":"Clin Chem Lab Med"},{"key":"2026082005383387300_hvag098-B26","doi-asserted-by":"crossref","first-page":"2519","DOI":"10.1515\/cclm-2024-0352","article-title":"Analytical validation of the Mindray CL1200i analyzer high sensitivity cardiac troponin I assay: MERITnI study","volume":"62","author":"Fabre-Estremera","year":"2024","journal-title":"Clin Chem Lab Med"},{"key":"2026082005383387300_hvag098-B27","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1093\/eurheartj\/ehaf975","article-title":"Long forms of cardiac troponin T for myocardial infarction diagnosis: the SuperTROPO study","volume":"47","author":"Teppo","year":"2026","journal-title":"Eur Heart J"},{"key":"2026082005383387300_hvag098-B28","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1515\/cclm-2024-1373","article-title":"Diagnostic performance of Mindray CL1200i high 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