Troponin I and Creatine Kinase MB do not provide comparable information after PCI
Carl Gunnar Gustavsson1, Margareta Nilson
1Department of Cardiology, University Hospital MAS, Malmoe, Sweden. CG@Gustavsson.se
Insights
Cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) levels were compared after PCI. Results show cTnI identifies significantly more procedure-related infarctions than CK-MB.
Area of Science:
- Cardiology
- Biomarker analysis
- Myocardial infarction detection
Background:
- Percutaneous coronary intervention (PCI) can lead to myocardial injury.
- Accurate detection of procedure-related myocardial infarction is crucial.
- Cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) are commonly used biomarkers.
Purpose of the Study:
- To compare the diagnostic performance of cTnI and CK-MB in detecting myocardial infarction after PCI.
- To evaluate biomarker elevation relative to the 99th percentile upper reference limit (URL).
Main Methods:
- Compared cTnI and CK-MB levels in 489 patients post-PCI with normal baseline levels.
- Stratified biomarker levels as multiples of the 99% URL.
- Defined procedure-related infarctions as levels > 3x 99% URL.
Main Results:
- cTnI elevation (> 3x 99% URL) occurred in 60% of patients, while CK-MB elevation occurred in 12%.
- cTnI was elevated (> 10x 99% URL) in all CK-MB infarction cases.
- CK-MB often remained normal despite elevated cTnI, indicating limited overlap.
Conclusions:
- The infarction rate after PCI is over five-fold higher when assessed by cTnI compared to CK-MB.
- cTnI demonstrates superior sensitivity for detecting procedure-related myocardial injury post-PCI.
Objectives:
To compare cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) after PCI in cases with normal baseline levels of both biomarkers.
Design:
cTnI and CK-MB after PCI were stratified as multiples of the 99(th) percent upper reference limit (99%URL) and compared to each other in 489 patients. Post-PCI levels > three times 99%URL were classified as procedure-related infarctions. Results. After PCI, CK-MB was > 3x 99%URL in 58/486 patients (12%) and cTnI > 3x 99%URL in 292/487 patients (60%). cTnI was > 10x 99%URL in all cases with infarction according to CK-MB but CK-MB was often normal despite elevated cTnI. There was an only minimal overlap between two infarction populations, those with cTnI in the range from 1x to 10x 99%URL and those with CK-MB 1x to 10x 99%URL.
Conclusions:
With the present quantification scales, infarction rate after PCI is > five-fold higher with cTnI than with CK-MB.
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