Research Article| Volume 17, ISSUE 4, P701-725, December 1997

Spectrum of Ischemic Heart Disease and The Role of Biochemical Markers

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      An exciting era exists as a result of the introduction of novel markers of myocardial damage. The prognostic implications with troponins, even in the setting of "minor myocardial damage," are potentially of immense value to patient care. We need to take the next step and assess the outcomes of interventions in these settings. Use of new markers at triage will probably allow for more efficient and safe disposition of patients in this setting. There are many advantages and disadvantages to the many present markers and many unanswered questions. Only through well designed large clinical trials will we be able to realize the true potential these markers possess.
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        • Abdelmeguid A.E.
        • Ellis S.G.
        • Sapp S.K.
        • et al.
        Defining the appropriate threshold of creatine kinase elevation after percutaneous coronary interventions.
        Am Heart J. 1996; 131: 1097-1105
        • Adams III., J.
        • Abendschein D.
        • Jaffe A.
        Biochemical markers of myocardial injury: Is MB creatine kinase the choice for the 1990s?.
        Circulation. 1993; 88: 750
        • Adams J.E.
        • Bodor G.S.
        • Davila-Roman V.G.
        • et al.
        Cardiac troponin I: A marker with high specificity for cardiac injury.
        Circulation. 1993; 88: 101-106
        • Adams J.E.
        • Sicard G.A.
        • Allen B.T.
        • et al.
        Diagnosis of perioperative myocardial infarction with measurements of cardiac troponin I.
        N Engl J Med. 1994; 330: 670-674
      1. American Heart Association: Heart and Stroke Facts: 1996 Statistical Supplement.
        American Heart Association, Dallas1996: 1-23
        • Anderson J.R.
        • Hossein-Nia M.
        • Brown P.A.
        • et al.
        Creatine kinase MB isoforms: A potential predictor of acute cardiac allograft rejection.
        J Heart Lung Transplant. 1995; 14: 666-670
        • Antman E.M.
        • Braunwald E.
        Acute myocardial infarction.
        in: Braunwald E. Heart Disease, A Textbook of Cardiovascular Medicine. ed 5. WB Saunders, Philadelphia1997: 1205
        • Antman E.M.
        • Grudzien C.
        • Sacks D.
        Evaluation of a rapid bedside assay for detection of serum cardiac troponin T.
        JAMA. 1995; 273: 1279
        • Antman E.M.
        • Grudzien C.
        • Sacks D.B.
        Evaluation of a rapid bedside assay for detection of serum cardiac troponin T.
        JAMA. 1995; 273: 1279-1282
        • Antman E.M.
        • Sacks D.
        • Nader R.
        • et al.
        Time to positivity of a rapid bedside assay for troponin T predicts prognosis in unstable angina [abstract].
        Circulation. 1996; 94: 1-322
        • Antman E.M.
        • Tanasijevic M.J.
        • Cannon C.P.
        • et al.
        Cardiac troponin I on admission predicts death by 42 days in unstable angina and improved survival with an early invasive strategy: Results from TIMI III B [abstract].
        Circulation. 1995; 92: 1-663
        • Antman E.M.
        • Tanasijevic M.J.
        • Thompson B.
        • et al.
        Cardiac specific troponin I levels to predict the risk of mortality in patients with acute ischemic syndromes.
        N Engl J Med. 1996; 335: 1342-1349
        • Bonnefoy E.
        • Chevalier P.
        • Kirorian G.
        • et al.
        Cardiac troponin I does not increase after electric countershock [abstract].
        Circulation. 1996; 94: 1-737
        • Christenson R.H.
        • Armstrong P.W.
        • O'Hanesian M.A.
        • et al.
        The value of serial troponin T measurements for risk stratification in patients with acute ischemic syndromes [abstract].
        Circulation. 1995; 92: 1-663
      2. Christenson RH, Ohman EM, Sigmon KN, et al: Combining myoglobin and clinical variables for assessing coronary reperfusion after thrombolytic therapy [abstract]. J Am Coll Cardiol, 44th Annual Scientific Session, 148A, 1995

        • Collinson P.O.
        • Stubbs P.J.
        • Roslalki S.B.
        Cardiac troponins and renal disease.
        Clin Chem. 1995; 41: 1671-1673
      3. Committee to Develop Guidelines for the Management of Patients with Acute Myocardial Infarction: Guidelines for the management of patients with acute myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 1996; 28: 1328-1428
        • Danchin N.
        Is myocardial revascularization for tight coronary stenosis always necessary? Viewpoint.
        Lancet. 1993; 342: 224
        • Ellis A.K.
        Serum protein measurements and the diagnosis of acute myocardial infarction.
        Circulation. 1991; 83: 1107
        • Feng Y.-J.
        • Chen L.
        • Ma I.
        • et al.
        Release of troponin T from short term hibernating myocardium subtending severe coronary stenosis [abstract].
        J Am Coll Cardiol. 1996; 27: 109A
        • Franz W.M.
        • Remppis A.
        • Kandolf R.
        • et al.
        Serum troponin T: Diagnostic marker for acute myocarditis.
        Clin Chem. 1996; 42: 340-341
        • Freeman M.R.
        • Langer A.
        • Wilson R.F.
        • et al.
        Thrombolysis in unstable angina: Randomized double-blind trial of t-PA and placebo.
        Circulation. 1992; 85: 150
        • Gentilucci M.
        • Yeh M.
        • Shirani J.
        • et al.
        Exercise training at conventional workload can negatively impact on the left ventricle in heart failure [abstract].
        J Am Coll Cardiol. 1997; 29: 425A
        • Genzer N.
        • Mair J.
        • Froedrich G.
        • et al.
        Uncomplicated successful transluminal coronary angioplasty does not affect cardiac troponin I plasma concentrations.
        Am J Cardiol. 1996; 78: 126-127
        • Goldman B.U.
        • Hamm C.W.
        • Schneider J.C.
        • et al.
        The value of bedside troponin T testing in the emergency room for risk stratification in patients with chest pain after discharge from hospital [abstract].
        J Am Coll Cardiol. 1996; 27: 359A
        • Goldmann B.U.
        • Heeschen C.
        • Möller R.H.
        • et al.
        A comparative study of troponin I and troponin T release in acute myocardial infarction [abstract].
        J Am Coll Cardiol. 1997; 29: 272A
      4. Granger C, Christopher D, Stebbins A, for Gusto Investigators: Thrombolytic therapy treats the tip of the iceberg: Results from the Gusto MI registry [abstract]. Circulation 90:1-663, 1994

        • Haiwachs G.
        • Iberer F.
        • Pieber T.
        • et al.
        Troponin T as a marker for post transplantation adaptational problems of the donor heart.
        J Heart Lung Transplant. 1996; 15: 451-455
        • Hamm C.W.
        • Ravlilde J.
        • Gerhardt W.
        • et al.
        The prognostic value of cardiac troponin T in unstable angina.
        N Engl J Med. 1992; 327: 146-150
        • Hossein-Nia M.
        • Mascaro J.
        • McKenna W.J.
        • et al.
        Troponin T as a non-invasive marker of cardiac allograft rejection.
        Lancet. 1993; 341: 838
        • Hossien-Nia M.
        • Holt D.W.
        • Anderson J.R.
        • et al.
        Cardiac troponin I release in heart transplantation.
        Ann Thorac Surg. 1996; 61: 277-278
      5. Ishii J, Nomura M, Ando T, et al: Heart fatty acid binding protein and myoglobin can accurately detect successful reperfusion as early as 15 minutes after reperfusion [abstract]. J Am Coll Cardiol 44th Annual Scientific Session, 147A, 1995

        • Karim M.A.
        • Shinn M.
        • Oskarsson H.
        • et al.
        Significance of cardiac troponin T release after percutaneous transluminal coronary angioplasty.
        Am J Cardiol. 1995; 76: 521-523
        • Katus H.A.
        • Remppis A.
        • Neumann F.J.
        • et al.
        Diagnostic efficiency of troponin T measurements in acute myocardial infarction.
        Circulation. 1991; 83: 902-912
        • Keen W.D.
        • Savage M.P.
        • Fischmann D.L.
        • et al.
        Comparison of coronary angiographic findings during the first six hours of non-Q-wave and Q-wave myocardial infarction.
        Am J Cardiol. 1994; 74: 324
        • Lee T.H.
        • Goldman L.
        Serum enzyme assays in the diagnosis of acute myocardial infarction.
        Ann Intern Med. 1986; 105: 221
      6. Lee TH, Thomas EJ, Johnson LE, et al: Troponin T and peri-operative ischemia in noncardiac surgery [abstract]. J Am Coll Cardiol 44th Annual Scientific Sessions, 25A, 1995

        • Lopez-Jimenez F.
        • Goldman E.J.
        • Thomas P.
        • et al.
        Independent long term prognostic value of troponin T for cardiac outcomes after non-cardiac surgery [abstract].
        J Am Coll Cardiol. 1997; 29: 273A
        • Mair J.
        • Morandell D.
        • Genser N.
        • et al.
        Equivalent early sensitivities of myoglobin, creatine kinase MB mass, creatine kinase isoform ratios and cardiac troponins I and T for acute myocardial infarction.
        Clin Chem. 1995; 41: 1266-1272
        • McLauren M.D.
        • Apple F.S.
        • Falahati A.
        • et al.
        A comparison of cardiac troponin I and CK-MB to rule out myocardial injury in hospitalized patients with renal insufficiency [abstract].
        Circulation. 1996; 94: 1-730
        • McLauren M.D.
        • Apple F.S.
        • Herzog C.A.
        • et al.
        Cardiac troponin T in chronic hemodialysis patients [abstract].
        Circulation. 1995; 92: 1-80
        • Missov E.
        • Calzolari C.
        • Pau B.
        • et al.
        High circulating levels of cardiac troponin I in human congestive heart failure [abstract].
        J Am Coll Cardiol. 1996; 27: 338A
        • Muller-Bardoff M.
        • Ramppis A.
        • Scheffold T.
        • et al.
        Monitoring of myocardial damage in patients undergoing radiofrequency catheter ablation.
        Circulation. 1994; 90: 1272
        • Muller-Bardoff M.
        • Hallmayer K.
        • Schroder A.
        • et al.
        Improved troponin T ELISA specific for the cardiac troponin T isoform. Development, analytical and clinical validation.
        Clin Chem. 1997; 43: 458-466
        • Myerburg R.J.
        • Castellanos A.
        Cardiac arrest and sudden cardiac death.
        in: Braunwald E. Heart Disease, A Textbook of Cardiovascular Medicine. ed 5. WB Saunders, Philadelphia1997: 746
        • Ohman E.M.
        • Armstrong P.W.
        • Christenson R.H.
        • et al.
        Cardiac troponin T levels for risk stratification in acute myocardial ischemia.
        N Engl J Med. 1996; 335: 1333-1341
      7. PACTS protocol, personal communication: Prognostic Accuracy of Cardiac Troponin Studies and Holter ST Monitoring. Armstrong PW, Ohman EM, Yatscoff RW, et al.

        • Pedoe-Tunstall H.
        • Kuulamasmaa K.
        • Amouyel P.
        • et al.
        Myocardial infarction and coronary deaths in the World Health Organization MONICA Project.
        Circulation. 1994; 90: 583
        • Pell S.
        • Fayerweather W.E.
        Trends in the incidence of myocardial infarction and in associated mortality and morbidity in a large employed population, 1957-1983.
        N Engl J Med. 1985; 312: 1005
        • Puleo P.R.
        • Perryman B.
        Noninvasive detection of reperfusion in acute myocardial infarction based on plasma activity of creatine kinase MB subfractions.
        J Am Coll Cardiol. 1991; 17: 1047
        • Puleo P.R.
        • Meyer D.
        • Wathen C.
        • et al.
        Use of a rapid assay of subforms of creatine kinase MB to diagnose or rule out acute myocardial infarction.
        N Engl J Med. 1994; 331: 561
        • Puleo P.R.
        • Gaudagno P.A.
        • Roberts R.
        • et al.
        Early diagnosis of acute myocardial infarction based on assay for subforms of creatine kinase MB.
        Circulation. 1990; 82: 759
        • Ravkilde J.
        • Horder W.
        • Gerhardt L.
        • et al.
        Diagnostic performance and prognostic value of serum troponin T in suspected acute myocardial infarction.
        Scand J Clin Lab Invest. 1993; 53: 677-685
        • Ravkilde J.
        • Nissen H.
        • Mickley H.
        • et al.
        Cardiac troponin T and CK-MB mass release after visually successful percutaneous transluminal coronary angioplasty in stable angina pectoris.
        Am Heart J. 1994; 127: 13-20
        • Ravkilde J.
        • Nissen H.
        • Horder M.
        • et al.
        Independent prognostic value of serum creatine kinase isoenzyme MB mass, cardiac troponin T and myosin light chains levels in suspected acute myocardial infarction.
        J Am Coll Cardiol. 1995; 25: 574-581
        • Remppis A.
        • Scheffold T.
        • Karrer O.
        • et al.
        Assessment of reperfusion of the infarct zone after acute myocardial infarction by serial cardiac troponin T measurements in the serum.
        Br Heart J. 1994; 71: 242-248
        • Riou B.
        • Dreux S.
        • Roche S.
        • et al.
        Circulating cardiac troponin T in potential heart transplant donors.
        Circulation. 1995; 93: 409-514
        • Rude R.E.
        • Poole W.K.
        • Muller J.K.
        • et al.
        Electrocardiographic and clinical criteria for recognition of acute myocardial infarction based on analysis of 3697 patients.
        Am J Cardiol. 1983; 52: 936-942
        • Sacks D.B.
        Troponin T: A cardiac specific-marker.
        in: Goldman L. Katus H.A. Cardiac Troponin T for the Diagnosis of Myocardial Injury. Discovery International, Deerfield, IL1994: 3
        • Talasz H.
        • Genser N.
        • Mair J.
        • et al.
        Side-branch occlusion during percutaneous transluminal coronary angioplasty.
        Lancet. 1992; 339: 1380-1382
        • Tanasijevic M.J.
        • Cannon C.P.
        • Wybenga D.R.
        • et al.
        Cardiac troponin I, CK-MB and myoglobin for early, non-invasive assessment of coronary reperfusion after thrombolysis for acute myocardial infarction.
        Results from TIMI-10 A [abstract]. Circulation. 1996; 94: 1-322
      8. TIMI-IIIB investigators: Effects of tissue-plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q-wave myocardial infarction: Results of the TIMI-IIIB trial.
        Circulation. 1994; 89: 1545
        • Yusuf S.
        • Pearson M.
        • Sterry H.
        • et al.
        The entry ECG in the early diagnosis and prognostic stratification of patients with suspected acute myocardial infarction.
        Eur Heart J. 1984; 5: 690-696
        • Zabel M.
        • Hohnloser S.H.
        • Koster W.
        • et al.
        Analysis of creatine kinase, CK-MB, myoglobin, and troponin T time-activity curves for early assessment of coronary artery reperfusion after intravenous thrombolysis.
        Circulation. 1993; 87: 1542-1550