Unstable angina non ST elevation myocardial infarction biomarkers
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Unstable angina / NSTEMI Microchapters |
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Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
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Additional Management Considerations for Antiplatelet and Anticoagulant Therapy |
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Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Cardiac markers are biomarkers that are measured to evaluate heart function. Their levels increase in blood when the heart muscle is necrosed, as in MI. Clinically the most commonly used cardiac markers include troponins and Creatine Kinase-MB (CK-MB). Other markers are lactate dehydrogenase, aspartate transaminase, myoglobin, ischemia modified albumin, pro-brain natriuretic peptide and glycogen phosphorylase isoenzyme. Cardiac biomarker measurement is one of the initial tests in a patient with heart attack.
Cardiac Biomarkers
If there is an elevation of a marker of myocardial necrosis (CK-MB or troponin), then the patient does not have unstable angina, but instead has a syndrome of either ST elevation MI or Non ST elevation MI depending upon the electrocardiogram changes.
According to consensus document in 2007[1] from the joint task force of the ESC, ACC, AHA and World Heart Federation (WHF), the term myocardial infarction is defined as myocardial necrosis in clinical setting consistent with myocardial ischemia with an elevation of troponin above the 99th percentile of normal together with any one of the following signs of ischemia:
- Symptoms of ischemia
- ECG changes indicative of new ischemia (new ST - T wave changes or new left bundle branch block)
- Development of pathological Q wave in ECG
- Imaging evidence of new wall motion abnormalities.
Creatine Kinase-MB
It is a cytosolic carrier protein for highenergy phosphates, has long been the standard marker for the diagnosis of MI. However, it is less sensitive and less specific for MI than cardiac troponins. However, it is useful in special clinical situations one of which is the diagnosis of early infarct extension (reinfarction), because the short half-life of CK-MB compared with troponin permits the detection of a diagnostic new increase after initial peak. Another situation is the diagnosis of a periprocedural MI, because the diagnostic and prognostic value of CK-MB in these situations has been extensively validated.
Cardiac Troponins
Cardiac troponin provides highly sensitive and specific result in detecting cell necrosis. There are 3 types of tropnins- Troponin T(cTnT), troponin I(cTnI) and troponin C(cTnC). Cardiac troponins refers specifically to either TnT or TnI. Because cTnT and cTnI generally are not detected in the blood of healthy persons, the cutoff value for elevated cTnT and cTnI levels may be set to slightly above the upper limit of the performance characteristics of the assay for a normal healthy population. Therefore, physicians need to know the sensitivity and the cut off of the test used in their hospital.
References
- ↑ Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M, Katus HA, Newby LK, Ravkilde J, Chaitman B, Clemmensen PM, Dellborg M, Hod H, Porela P, Underwood R, Bax JJ, Beller GA, Bonow R, Van der Wall EE, Bassand JP, Wijns W, Ferguson TB, Steg PG, Uretsky BF, Williams DO, Armstrong PW, Antman EM, Fox KA, Hamm CW, Ohman EM, Simoons ML, Poole-Wilson PA, Gurfinkel EP, Lopez-Sendon JL, Pais P, Mendis S, Zhu JR, Wallentin LC, Fernández-Avilés F, Fox KM, Parkhomenko AN, Priori SG, Tendera M, Voipio-Pulkki LM, Vahanian A, Camm AJ, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Morais J, Brener S, Harrington R, Morrow D, Lim M, Martinez-Rios MA, Steinhubl S, Levine GN, Gibler WB, Goff D, Tubaro M, Dudek D, Al-Attar N (2007). "Universal definition of myocardial infarction". Circulation. 116 (22): 2634–53. doi:10.1161/CIRCULATIONAHA.107.187397. PMID 17951284. Retrieved 2011-04-11. Unknown parameter
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