[Troponins and other biochemical cardiac markers--time for a change]

Abstract

Background: During the last ten years new, more sensitive and specific cardiac markers in blood for detection of acute myocardial injuries have been characterised and clinically evaluated. Of practical importance is also the fact that rapid and robust methods and equipments suitable for emergency service have been developed.

Material and methods: Based on literature study and on own experiences we give a survey of the most promising cardiac markers with emphasis on the troponin T and troponin I.

Results: Methodological and pathobiochemical aspects are discussed. The diagnostic characteristics and advantages of the new markers are in focus, especially with respect to early detection of acute myocardial injuries. Finally, we discuss their potential use for stratification of patients with acute coronary syndromes with respect to optimal treatment, resource-saving monitoring, and more precise prognostication.

Interpretation: It is recommended that one of the troponins, either I or T, should be included in the diagnostic regime for detecting acute coronary syndromes in Norwegian hospitals. CKMB, determined as mass and not as activity, ought to be retained, at least until more clinical experience with the troponins have been gained by the hospital. Myoglobin may only be of interest if early exclusion of myocardial injuries has practical consequences. In this connection the transaminases and LDH are no longer of any interest.