SICU Journal Meeting

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SICU Journal Meeting

• Troponin I vs CK-MB
• Is It Time for A Change?
• Ri ???

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Why do we measure it?

• To detect new ACS(UA/MI)
• To monitor post op course
• Prognosis
• Risk stratification
• Choice of further treatment
• Clinical study

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ACS Concept
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• ACC/AHA 2002 Guideline Update for the Management
  of Patients With Unstable Angina and
  NonST-Segment Elevation Myocardial Infarction

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• ACC/AHA 2002 Guideline Update for the Management
  of Patients With Unstable Angina and
  NonST-Segment Elevation Myocardial Infarction

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• National Academy of Clinical Biochemistry,
  November 5, 1999.

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CKMB
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Troponin
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Mortality Rates at 42 Days According to the Level
of Cardiac Troponin I Measured at Enrollment
Antman, E. M. et. al. N Engl J Med
19963351342-1349
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Mortality Rates at 42 Days According to the Time
from the Onset of Pain to Study Enrollment and
the Base-Line Cardiac Troponin I Levels
Antman, E. M. et. al. N Engl J Med
19963351342-1349
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• Am J Cardiol 1998811405-10.

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Why is it sensitive specific?

• cardiac troponin I not normally circulate in the
  blood and is 13 times more abundant in the
  myocardium than CK-MB
• ?low signal-to-noise ratio
• elevated CK-MB levels confounded by injury of
  skeletal muscles
• Clin Chem 1994401291-1295.

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Odds Ratios for Cardiac Events Associated with
Treatment with Abciximab at the Six-Month
Follow-up, in Subgroups of Patients Defined
According to Serum Troponin T (TnT) Level, Serum
Creatine Kinase MB Fraction (CK-MB), ST-Segment
Depression, and T-Wave Inversion
Hamm, C. W. et. al. N Engl J Med
19993401623-1629
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Ability of Minor Elevations of Troponins I and T
to Predict Benefit From an Early Invasive
Strategy in Patients With Unstable Angina and
Non-ST Elevation Myocardial Infarction

• JAMA. 20012862405-2412.

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ACS Risk Stratification

• Circulation. 2000102118-122.

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ESC ACC Panel on Biochemistry

• Its Time for a Change to a Troponin Standard
• Cardiac troponins (I or T) the preferred markers
  for the diagnosis of myocardial injury
• The diagnostic and prognostic value of
  elevations irrespective of the mechanism of
  cellular injury
• The term myocardial infarction evidence of
  cardiac damage, as detected by marker proteins in
  a clinical setting consistent with myocardial
  ischemia
• Circulation. 20001021216-1220.

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ESC ACC Panel on Biochemistry

• Patients who undergo interventional procedures
  and cardiac surgery have elevations because of
  the procedures.
• Classification of elevations, their significance,
  and the care of patients that results should be
  individualized to these groups.
• Circulation. 20001021216-1220.

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AHA Scientific StatementDefinitions for Acute
Coronary Heart Disease in Epidemiology and
Clinical Research Studies

• The order of diagnostic value cTngtCK-MBmgtCK-MBgtCK
  .
• Adequate set of biomarkers At least 2
  measurements of the same marker taken at least 6
  hours apart
• Diagnostic biomarkers At least 1 positive
  biomarker in an adequate set of biomarkers
  showing a rising or falling pattern in clinical
  cardiac ischemia and the absence of noncardiac
  causes of biomarker elevation
• Circulation. 20031082543.

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Diagnosis of Perioperative Myocardial Infarction
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Peak Cardiac Troponin I Mass in Patients with and
without Perioperative Myocardial Infarction
Adams, J. E. et. al. N Engl J Med 1994330670-674
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Peak MB Creatine Kinase Mass in Patients with and
without Perioperative Myocardial Infarction
Adams, J. E. et. al. N Engl J Med 1994330670-674
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Cardiac Troponin I Predicts Short-Term Mortality
in Vascular Surgery Patients

• Circulation. 20021062366

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• Circulation. 20021062366.

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For CABG

• Eur J Cardiothorac Surg. 19981357-65.

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• Eur J Cardiothorac Surg. 19981357-65.

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cTnI qualifies as a useful tool

• (1)a quick diagnostic test with high specificity
  for myocardial tissue
• (2)high diagnostic efficiency of 94 at 12 h and
  98 at 24 h( cut-off value 9.8, 11.6 ng/ml)
• sensitivity100, specificity 97
• (3)sufficient by a single determination 24 h post
  op for diagnosis of PMI and quantitation of the
  amount of myocardial damage
• Eur J Cardiothorac Surg. 19981357-65.

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Shall we measure it?

• To detect new ACS(UA/MI)
• To monitor post op course
• Prognosis
• Risk stratification
• Choice of further treatment
• Clinical study

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Cost in NTUH

• CKMB 150 NT
• Troponin I 450 NT

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Thanks for Your Attention