Sensitive troponins overpower complex cpk--mb

Abstract

Annually, several million patients seek care in the emergency department because of chest pain or other symptoms suggesting an acute coronary syndrome (ACS), but only about 10% are subsequently confirmed to have acute myocardial infarction (AMI).1Blood testing for biomarkers of myocardial injury plays an increasingly important role for the evaluation, diagnosis, and triage of patients with chest pain. The guidelines for the diagnosis of myocardial infarction (MI) have recently changed and prominently incorporate the results of cardiac marker testing in the clinical definition of MI. We review these updated guidelines for MI definition as it pertains to cardiac biomarker testing and further compare the differing biology and release kinetics of clinically relevant biomarkers. Finally, we define the contemporary use of cardiac biomarker testing for patients with chest pain, including appropriate integration of point-of-care testing into (POCT) day-to-day clinical use. Ideally, sensitive and specific serum myocardial markers could provide the basis for early detection as well as determine the status of reperfusion following thrombolytic therapy. The present study examined the utility of cardiac troponin I (cTnI), and CK-MB, for the sensitive and specific detection of AMI in 54 consecutive patients presenting to the emergency department (ED) with chest pain. In addition, cardiac troponin T (cTnT) samples were measured to following thrombolytic therapy to assess reperfusion. However, cTnI was the most specific serum marker (specificity 91.9% compared to CK-MB 85.6%). In the reperfusion study, cTnT and, CK-MB’s, relative increases were greater more significant .Within the reperfused group, the relative increase of cTnT was greater than CK-MB at 90 min following thrombolytic therapy. These findings show the clinical utility of cardiac-specific troponins as markers for the early detection of AMI and monitoring of reperfusion following thrombolytic therapy. With so many advances in the knowhow of myocardial pathology, it becomes mandatory to suggest new parameters and to compare them to highlight the biochemical support that has gone miles since its inception. The study population consisted of 70 patients. Patients from both sexes, with clinical history of typical chest pain for more than 30 minutes in duration with evidence of acute changes of myocardial infarction on ECG were included in the study. This study was conducted to compare the sensitivity of creatine kinase-MB (CK-MB), cardiac troponin T (CTnT) and cardiac troponin I (CTnI) for detection of AMI. Data analysis was performed with Statistical Package for Social Sciences 11.5 (SPSS 11.5). The sensitivity of CK-MB was 90% and 48% as compared to CTnT and CTnI respectively. The sensitivity of CTnT was 46% and 69% as compared to CK-MB and CTnI respectively while the sensitivity of CTnI was100% as compared to both CK-MB and CTnT. : It is concluded that cTnI is the preferred, more precise, dependable and cost effective serum marker for detection of AMI as compared to CTnT and CK-MB