markers of myocardial injury/infarction
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Indications
- generally obtained in emergency department or hospital setting for rule out myocardial infarction (MI)
Benefit/risk
- sensitivity of negative markers is 98.8% for rule out MI increased to 99.6% for a 2nd set of markers 6 hours later[4]
Laboratory
Markers of myocardial infarction include:
- serum myoglobin
- MW: 17,800
- time to appear in serum: 0.5-2h
- time to peak serum level: 5-12h
- time to return to baseline: 8-30h
- degree of elevation: 5-20 fold
- serum creatine kinase (CK) MB index: CK MB / total CK (serum)
- cardiac-specific troponin-I
- MW: 22,500
- time to appear in serum: 3-6h
- time to peak serum level: 14-20h
- time to return to baseline: 5-15days
- degree of elevation: 20-50 fold
- LDH isozymes by electrophoresis
- investigational markers[2]
- serum C-reactive protein
- serum myeloperoxidase [2a]
- serum glutathione peroxidase-1 (negative marker)[3]
- serum interleukin-6
- serum homocysteine
Management
- dabigatran 110 mg BID after non-cardiac surgery-induced myocardial ischemia lowers risk of major vascular complications[5]
Additional terms
References
- ↑ Plaut D, Advance/Laboratory July, 2001
- ↑ 2.0 2.1 Brennan M-L et al N Engl J Med 349:1595, 2003 Prognostic value of myeloperoxidase in patients with chest pain. PMID: https://www.ncbi.nlm.nih.gov/pubmed/14573731
- ↑ 3.0 3.1 Blankenberg S et al Glutathione peroxidase 1 activity and cardiovascular events in patients with coronary artery disease. N Engl J Med 349:1605, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14573732
- ↑ 4.0 4.1 The NNT: Risk Assessment: Low Risk Chest Pain Over Age 40 in the Emergency Department. http://www.thennt.com/risk/low-risk-chest-pain-over-age-40/
The NNT: Risk Assessment: Low Risk Chest Pain Under Age 40 in the Emergency Department http://www.thennt.com/risk/low-risk-chest-pain-under-age-40/ - ↑ 5.0 5.1 Devereaux PJ, Duceppe E, Guyatt G et al Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE): an international, randomised, placebo- controlled trial. Lancet. 2018 Jun 9;391(10137):2325-2334. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29900874