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markers of myocardial injury/infarction

Indications: - generally obtained in emergency department or hospital setting for rule out myocardial infarction (MI) Benefit/risk: - sensitivity of negative markers is 98.8% for rule out MI increased to 99.6% for a 2nd set of markers 6 hours later [4] Laboratory: Markers of myocardial infarction include: 1) serum myoglobin a) MW: 17,800 b) time to appear in serum: 0.5-2h c) time to peak serum level: 5-12h d) time to return to baseline: 8-30h e) degree of elevation: 5-20 fold 2) serum creatine kinase (CK) MB index: CK MB / total CK (serum) a) MW: 86,000 (CK, CK-MB) b) time to appear in serum: 1-4h, 3-8h for CK or CK-MB c) time to peak serum level: 4-8h, 10-30 for CK or CK-MB d) time to return to baseline: 12-24h, 2-2 days for CK-MB e) degree of elevation: 3-5 fold, 5-20 fold for CK-MB 3) cardiac-specific troponin-I a) MW: 22,500 b) time to appear in serum: 3-6h c) time to peak serum level: 14-20h d) time to return to baseline: 5-15days e) degree of elevation: 20-50 fold 4) LDH isozymes by electrophoresis 5) investigational markers [2] a) serum C-reactive protein b) serum myeloperoxidase [2a] c) serum glutathione peroxidase-1 (negative marker) [3] d) serum interleukin-6 e) serum homocysteine Management: - dabigatran 110 mg BID after non-cardiac surgery-induced myocardial ischemia lowers risk of major vascular complications [5]

Related

creatine kinase MB (CKMB) in serum troponin-I in serum/plasma

References

  1. Plaut D, Advance/Laboratory July, 2001
  2. Brennan M-L et al N Engl J Med 349:1595, 2003 Prognostic value of myeloperoxidase in patients with chest pain. PMID: 14573731
  3. Blankenberg S et al Glutathione peroxidase 1 activity and cardiovascular events in patients with coronary artery disease. N Engl J Med 349:1605, 2003 PMID: 14573732
  4. The NNT: Risk Assessment: Low Risk Chest Pain Over Age 40 in the Emergency Department. http://www.thennt.com/risk/low-risk-chest-pain-over-age-40/ - The NNT: Risk Assessment: Low Risk Chest Pain Under Age 40 in the Emergency Department http://www.thennt.com/risk/low-risk-chest-pain-under-age-40/
  5. Devereaux PJ, Duceppe E, Guyatt G et al Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE): an international, randomised, placebo- controlled trial. Lancet. 2018 Jun 9;391(10137):2325-2334. PMID: 29900874