Markers of Myocardial Injury
2006 Clinical Chemistry Resident Conference
Markers of Myocardial Injury
Jannie Woo, Ph.D. Clinical Pathology SUNY Upstate Medical University
Objectives
CKMB is no longer the ideal cardiac marker Troponins I & T are the cardiac markers of the 21st Century Redefining Myocardial Infarction Multi-biomarker risk stratification Biomarkers in renal disease
Diagnosis of AMI
Based on 2 out of 3 of WHO criteria (Circulation, 1979)
Prolonged chest pain
"Silent infarct", Painless infarct
ECG changes
Lacks sensitivity
Serum enzyme concentrations
CKMB lacks sensitivity in diagnosis of perioperative MI
Protein markers, e.g. troponins, myoglobin & others emerging in the 21st century
Limitation of CKMB
FP incidents in perioperative patients without cardiac injury False elevations in
Skeletal muscle injury Marathon runners Chronic renal failure Hypothyroidism
MI detection not timely enough for thrombolytic intervention. MB peaking takes >12h
Need for New Cardiac Markers
Timely diagnosis of MI for thrombolytic therapy Identify successful reperfusion after thrombolysis in MI Diagnosis of perioperative MI
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