Immunochemistry Analyzers for Cardiac Markers: Choosing a Platform

Immunochemistry analyzers are the backbone of laboratory cardiac diagnostics. They provide quantitative measurement of high-sensitivity troponin (hs-cTnI/T), natriuretic peptides (NT-proBNP, BNP), D-dimer and other markers of cardiovascular disease. The choice of platform determines the laboratory's accuracy, speed and cost-effectiveness.

Principles of Immunochemical Analysis

Modern analyzers use two main detection methods:

• Chemiluminescence (CLIA): Abbott ARCHITECT, Beckman Access; an enzymatic reaction that generates photons, high sensitivity;
• Electrochemiluminescence (ECLIA): Roche Elecsys/cobas; electrochemical activation of a ruthenium complex, wide linear range;
• PETIA / turbidimetry: additional channels for D-dimer, ferritin and CRP;
• All platforms offer full automation, from sample preparation to result reporting.

Main Platforms for Cardiac Markers

Leading manufacturers offer the following systems:

Abbott ARCHITECT / Alinity i

The Abbott ARCHITECT i2000SR line and its successor, Alinity i, are the most widely used platforms for hs-cTnI in Central Asia and Eastern Europe. Key advantages:

• High-sensitivity troponin I (STAT hs-cTnI) with a 99th percentile of 26 ng/L;
• A sex-independent cutoff that simplifies interpretation;
• Multiplex format: cTnI + CK-MB + myoglobin in a single run;
• Integration with Abbott AlinIQ for QC data management;
• An extensive service network in the region.

Roche cobas e 801 / e 411

The Roche Elecsys electrochemiluminescence platform is the only one that uses troponin T (hs-cTnT):

• A 99th percentile of 14 ng/L, the lowest among the platforms;
• The ESC-recommended 0/1h and 0/2h algorithms were developed specifically for hs-cTnT;
• cobas e 801: up to 300 tests/hour, modular integration with cobas c 702;
• cobas e 411: a compact analyzer for mid-volume clinics;
• Roche NT-proBNP is one of the most extensively validated markers of chronic heart failure.

Platform Selection Criteria

When choosing an immunochemistry analyzer for a cardiology laboratory, consider:

• Analytical sensitivity: the CV at the 99th percentile should be < 10% (ideally < 5%);
• Throughput: matching the patient flow (60–440 tests/hour);
• Assay menu: completeness of the cardiac panel (cTn, BNP/NT-proBNP, D-dimer, CK-MB, myoglobin);
• LIS integration: HL7/ASTM support, automatic result transfer;
• Cost per test: including reagents, calibrators and control materials;
• Service support in the region: availability of engineers, reagent delivery times.

Integration with Clinical Algorithms

Modern laboratories are implementing automated algorithms for interpreting cardiac markers:

ESC 0/1h algorithm for hs-cTnT (Roche): with < 5 ng/L at presentation and a Δ < 3 ng/L after 1 hour, MI is ruled out with an NPV > 99.5%. Similar algorithms exist for hs-cTnI (Abbott, Siemens).

Integrating these rules directly into the LIS makes it possible to generate comments automatically and direct patients along the appropriate clinical pathway.

Conclusion

Choosing an immunochemistry platform for cardiac markers is a strategic decision that determines diagnostic quality for years to come. KombiMED supplies Abbott, Roche, Siemens and Beckman Coulter systems with full support, from validation and training to external quality assessment programmes.