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A Comparison of Biomarker Rise in Type 1 and Type 2 Myocardial Infarction

Amit K Pandey1, Thao Duong2, Iwona Swiatkiewicz3

  • 1Division of Internal Medicine; University of California San Diego, La Jolla, CA.

The American Journal of Medicine
|April 3, 2020
PubMed

Insights

Type 1 myocardial infarction shows higher cardiac troponin (cTn) and creatine kinase MB (CK-MB) rises than type 2. Type 2 myocardial infarction exhibits a disproportionate cTn rise relative to CK-MB, aiding differentiation.

Area of Science:

  • Cardiology
  • Biochemistry

Background:

  • Type 1 and type 2 myocardial infarction (MI) share diagnostic criteria, complicating clinical differentiation.
  • Accurate differentiation is crucial as management strategies differ significantly between MI types.

Purpose of the Study:

  • To compare the kinetic patterns of cardiac troponin (cTn) and creatine kinase MB (CK-MB) rise in type 1 versus type 2 MI.
  • To identify potential biomarkers for distinguishing between these MI subtypes.

Main Methods:

  • Retrospective analysis of 200 non-ST-elevation MI patients (97 type 1, 103 type 2).
  • Calculation of percentage rise from trough to peak and peak-to-upper-limit-of-normal (RULN) ratios for cTnT and CK-MB.
  • Assessment of the ratio of peak cTnT to peak CK-MB, adjusted for sex, GFR, and infarct size.

Main Results:

  • Type 1 MI demonstrated significantly higher mean percentage rises and RULN for both cTnT and CK-MB compared to type 2 MI.
  • A trend towards a higher cTnT to CK-MB ratio was observed in type 2 MI (0.09) versus type 1 MI (0.06), persisting after adjustments.
  • Type 1 MI events were generally larger than type 2 MI events.

Conclusions:

  • Cardiac troponin T (cTnT) and CK-MB levels rise higher in type 1 MI than in type 2 MI.
  • Type 2 MI is characterized by a cTnT rise that is disproportionate to the CK-MB rise.
  • These kinetic differences offer valuable insights for differentiating and managing patients with type 1 versus type 2 myocardial infarction.
Abstract

Keywords:
Cardiac troponinCreatine kinase MBType 1 myocardial infarctionType 2 myocardial infarction

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