Dr. V. Bhayana
BSc, India; PhD, Manitoba; Post-doc, Calgary
Associate Professor
Division of Clinical Biochemistry
Dept. of Biochemistry
Clinical Biochemist
London Health Sciences Centre
519-685-8500 x35775
vbhayana@uwo.ca
Acute Myocardial Infarction and Immunodiagnostics
Early and accurate identification and confirmation of acute myocardial
infarction (AMI) is important for treatment and early triage of patients
from the emergency department (ED). Most physicians in the ED rely
heavily on electrocardiography (ECG) results, even though
about half of all AMI patients have nondiagnostic ECGs. To alleviate
this problem, several biochemical markers have been used for the early
diagnosis of AMI.
Of the commercially available assays, myoglobin and isoforms of creatine kinase-2 (CK; EC2.7.3.2) are regarded as the earliest markers; however, the cardiac specificity of both is questionable. CK-2 mass is, at present, widely used in combination with total CK. Both CK and CK-2 mass have poor sensitivity in the early stages of AMI, and false positives are found in patients with skeletal muscle damage.
Cardiac troponin T, in contrast, has been reported as the
most specific biochemical marker of AMI. The initial increases of
troponin T after AMI is similar to that of CK-2 mass, while troponin T
remains elevated for as long as 10 days after AMI and CK-2 mass returns
to baseline within 2 days. Most early investigations showed almost
absolute specificity of troponin T for cardiac damage. Many other
cardiac markers have surfaced within the last few years, but none of them
is being extensively used in the routine clinical laboratory.
We are at present involved in the evaluation and possible routine use of some of the new cardiac markers in our laboratory.
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Updated by L. Weir, Apr 2010.
