A Comparison of Biomarker Rise in Type 1 and Type 2 Myocardial Infarction
| Autor: | Amit K. Pandey, Iwona Swiatkiewicz, Lori B. Daniels, Thao Duong |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Cardiac troponin business.industry Renal function General Medicine 030204 cardiovascular system & hematology medicine.disease Infarct size Creatine kinase.MB Pathophysiology 03 medical and health sciences 0302 clinical medicine Troponin complex Internal medicine cardiovascular system medicine Cardiology Biomarker (medicine) cardiovascular diseases 030212 general & internal medicine Myocardial infarction business |
| Zdroj: | The American Journal of Medicine. 133:1203-1208 |
| ISSN: | 0002-9343 |
| DOI: | 10.1016/j.amjmed.2020.02.024 |
| Popis: | Background Despite differing underlying pathophysiology, type 1 and type 2 myocardial infarction share many of the same diagnostic criteria and can be challenging to differentiate in clinical practice. Correctly differentiating type 1 from type 2 myocardial infarction is important because they are managed differently. The aim of this study was to compare the patterns of rise of cardiac troponin (cTn) and creatine kinase MB (CK-MB) in type 1 and type 2 myocardial infarction. Methods We analyzed retrospective data on 200 patients with myocardial infarction (97 with type 1, 103 with type 2), excluding patients with ST-segment elevation myocardial infarction. The percentage rise from trough to peak values and the ratio of the peak to the upper limit of normal (RULN) were calculated for both cardiac troponin T (cTnT) and CK-MB. The ratio of peak cTnT to peak CK-MB was also calculated before and after adjusting for sex, glomerular filtration rate (GFR), and infarct size. Results Type 1 myocardial infarction tended to be larger than type 2 myocardial infarction, with a significantly higher mean percentage rise for both cTnT and CK-MB as well as higher mean RULN (207 vs 86 for cTnT, P = 0.02; 9 vs 4 for CK-MB, P = 0.002). There was a trend toward a higher rise of cTnT than CK-MB in type 2 compared with type 1 myocardial infarction, as demonstrated by the ratio of peak cTnT to peak CK-MB (0.09 in type 2 myocardial infarction vs 0.06 in type 1 myocardial infarction, P = 0.06). This difference persisted after adjusting for sex, GFR, and infarct size (P = 0.05). Conclusion Both cTnT and CK-MB rise higher in type 1 than in type 2 myocardial infarction. Meanwhile, cTnT tends to rise out of proportion to CK-MB in type 2 myocardial infarction. These patterns may have considerable implications for the differentiation and subsequent treatment of patients with type 1 versus type 2 myocardial infarction. |
| Databáze: | OpenAIRE |
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