A rapid postmortem cardiac troponin T assay - Laboratory evidence of sudden cardiac death

Postmortem examination may be useful in establishing the cause of sudden un expected death. In many instances, however, limitations of staffing, budget , and time may force the pathologist to triage cases to external examinatio n rather than autopsy. A rapid assay for cardiac troponin T (cTnT) to docum ent suspected cardiac-related deaths may optimize the use of the time and r esources of the autopsy pathologist. Peripheral blood was sampled percutane ously before each of 40 autopsies and placed in the well of the Cardiac T R apid Assay unit in accordance with the included instructions, and the resul ts were read after 15 minutes. The assay result, decedent age, postmortem i nterval, and evidence of cardiopulmonary resuscitation were tabulated and s ubsequently correlated with the cause of death. On final sign-out of each o f the autopsies, the cause of death was determined to be cardiac-related (n = 20) versus the cause in noncardiac control subjects (n = 20). This deter mination was made while the investigators were blinded to the cTnT assay re sult. Of the 20 cardiac deaths, 17 (85%) showed positive results for cTnT c ompared with 6 (30%) false-positive results among the 20 control cases; thi s result was statistically significant according to the chi-square test. In the over-50 age group, the sensitivity of this assay in detecting cardiac- related death was 91%, with a specificity of 86%. Perimortem cardiopulmonar y resuscitation did not appear to result in false-positive results. In the appropriate setting, this rapid assay for cTnT can provide valuable data su pportive of a cardiac-related death. This inexpensive test may best be used in triaging sudden deaths in persons over 50 to external examination versu s complete autopsy.