Related Experiment Video
Updated: Aug 21, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Cardiovascular outcome in hospitalized patients with minimal troponin I elevation and normal creatine phosphokinase
Komandoor Srivathsan1, John Showalter, James Wilkens
1Division of Cardiovascular Diseases and Hospital Internal Medicine, Mayo Clinic Scottsdale, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA. srivathsan.komandoor@mayo.edu
Insights
Hospitalized patients with minimally elevated cardiac troponin I and normal creatine phosphokinase MB fraction face a significant risk of adverse cardiovascular events. This includes death, myocardial infarction, and re-hospitalization within one year.
Area of Science:
- Cardiology
- Clinical Biochemistry
- Internal Medicine
Background:
- Elevated cardiac troponin and creatine phosphokinase MB fraction (CK-MB) are key indicators in acute coronary syndrome.
- However, cardiac biomarkers are frequently measured in diverse clinical settings for hospitalized patients.
- Some patients exhibit elevated troponin levels without a corresponding rise in CK-MB.
Purpose of the Study:
- To assess the cardiovascular outcomes in acutely ill, hospitalized patients presenting with minimal troponin I elevation and normal CK-MB levels.
- Investigate the prognostic significance of this specific biomarker profile.
Main Methods:
- Retrospective analysis of 64 hospitalized patients between November 1998 and April 2000 with minimal troponin I increase and normal CK-MB.
- Data collection via structured questionnaires for re-hospitalization (myocardial infarction, unstable coronary syndrome, heart failure, PCI) and hospital records for in-hospital deaths.
- Primary outcomes included death, myocardial infarction, revascularization, and cardiac re-hospitalization.
Main Results:
- A composite endpoint of death, myocardial infarction, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or cardiac re-hospitalization occurred in 35.95% of patients within one year.
- This indicates a substantial risk associated with the studied biomarker profile.
Conclusions:
- Acutely ill hospitalized patients with minimally elevated troponin I and normal CK-MB demonstrate a significant rate of composite cardiovascular events.
- These adverse outcomes occur irrespective of the primary reason for hospitalization.
- The findings underscore the clinical importance of monitoring these patients closely for cardiac events.
Background:
Among patients with acute coronary syndrome, elevated cardiac troponin and creatine phosphokinase MB fraction levels have both prognostic and diagnostic values. However, in hospitalized patients, cardiac biomarkers are measured in a variety of clinical situations including but not limited to acute coronary syndrome. Moreover, these patients may have elevated troponin levels with no increase in creatine phosphokinase MB fraction levels.
Objective:
To evaluate the cardiovascular outcome of acutely ill, hospitalized patients with minimal troponin I increase with normal creatine phosphokinase MB fraction.
Methods:
We identified 64 patients retrospectively from our database with minimal troponin I increase and normal creatine phosphokinase MB fraction hospitalized between November 1998 and April 2000. Discharged patients were questioned about re-hospitalization for myocardial infarction, unstable coronary syndrome, congestive heart failure and percutaneous coronary intervention by means of a structured questionnaire. For those patients who died during hospitalization, data were collected from hospital records. For patients who died at home or at a different institution, a surviving relative completed the questionnaire. Primary outcomes were death, myocardial infarction and the need for revascularization or re-hospitalization.
Results:
Composite endpoint of death, myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting and re-hospitalization for cardiac cause occurred in 35.95% of patients within 1 year.
Conclusions:
There is a significant composite event rate of death, myocardial infarction or re-hospitalization for cardiac causes in acutely ill, hospitalized patients with normal creatine phosphokinase MB fraction and minimally elevated troponin I, regardless of the cause for hospitalization.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:28Cardiac Catheterization I: Pre-Procedure Overview