Improved detection of minor ischemic myocardial injury with measurement of serum cardiac troponin I

This study compared the diagnostic accuracy of the measurement of serum cardiac troponin I (cTnI) with creatine kinase (CK) MB mass in patients with minor myocardial injury whose measured total CK activity did not exceed twice the upper reference limit (300 U/L for men; 200 U/L for women). Forty-eig...

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Bibliographic Details
Published in:Clinical chemistry (Baltimore, Md.) Md.), 1997-11, Vol.43 (11), p.2047-2051
Main Authors: Apple, Fred S, Falahati, Alireza, Paulsen, Pamela R, Miller, Elizabeth A, Sharkey, Scott W
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Biomarkers - blood
Cardiology. Vascular system
Cardiovascular system
Coronary heart disease
Creatine Kinase - blood
Electroencephalography
Female
Heart
Humans
Investigative techniques, diagnostic techniques (general aspects)
Isoenzymes
Male
Medical sciences
Middle Aged
Myocardial Ischemia - blood
Myocardial Ischemia - diagnosis
Myocardial Ischemia - diagnostic imaging
Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques
Retrospective Studies
Sensitivity and Specificity
Troponin I - blood
Ultrasonography
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Summary:This study compared the diagnostic accuracy of the measurement of serum cardiac troponin I (cTnI) with creatine kinase (CK) MB mass in patients with minor myocardial injury whose measured total CK activity did not exceed twice the upper reference limit (300 U/L for men; 200 U/L for women). Forty-eight consecutive patients presenting with chest pain and with in-hospital documentation of myocardial injury were enrolled. Electrocardiogram, echocardiogram, and serial serum CK-MB mass, cTnI, and total CK were measured over 36 h after admission. Peak total CK activity was within normal limits in 28 patients (58%). The mean (+/- SD) peak CK-MB mass and cTnI concentrations were: 16.4 (11.8) micrograms/L and 132 (13.0) micrograms/L; respectively. The peak biochemical marker index (defined as CK-MB or cTnI divided by its respective upper reference limit) was significantly (P < 0.05) higher for cTnI than for CK-MB from 7 to 36 h. The clinical sensitivity for detection of myocardial injury for cTnI was 100% [95% confidence interval (CI): 87.2% to 100%], compared with 81.8% (CI: 67.3% to 91.8%) for CK-MB. Thus, cTnI was more sensitive than CK-MB mass for detection of myocardial injury in patients with small increases of total CK.
ISSN:0009-9147
1530-8561
DOI:10.1093/clinchem/43.11.2047