Myocardial Markers of Injury:<i>Evolution and Insights</i>

Keffer, Joseph H.

doi:10.1093/ajcp/105.3.305

Cited by 98 publications

(36 citation statements)

References 84 publications

(112 reference statements)

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“…It is a cytoplasmic protein derived from the damaged 24 found that the sensitivity of CPK-MB was higher than the sensitivity of Troponin-I in the fi rst 2 to 5 hours of cardiac damage. In our study, in the fi rst 0-4 hours, the sensitivity and the specifi city of H-FABP were 99% and 99%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Heart Type Free Fatty Acid Binding Protein, CPK-MB and Troponin-I in the early diagnosis of acute coronary syndrome

Aktuğlu¹,

Tunca²,

Atalay³

et al. 2012

Kafkas J Med Sci

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AIM: Heart type free fatty acid binding protein (H-FABP) is a new marker of myocyte damage used in the early diagnosis (within the fi rst two hours) of acute myocardial infarction (AMI). The aim of our study was to evaluate the cardio-sensitivity and specifi city of H-FABP during the acute phase of the AMI in comparison with creatinine phsphokinase-m band (CPK-MB) and troponin-I. METHODS: ÖZET AMAÇ: Kalp tipi serbest yağ asidi bağlayıcı protein (H-FABP) akut myokard infarktüsünün (AMI) erken dönem (ilk iki saat) tanısında kullanılan ve myosit hasarını gösteren yeni bir belirteçdir. Bu açlıșmanın amacı H-FABP'nin kardiyak duyarlılığını ve özgüllüğünü, kreatinin fosfokinaz (CPK-MB) ve Troponin-I ile karșılaștırarak tanımlamaktır. YÖNTEM:

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Section: Discussionmentioning

confidence: 99%

Comparison of Heart Type Free Fatty Acid Binding Protein, CPK-MB and Troponin-I in the early diagnosis of acute coronary syndrome

Aktuğlu¹,

Tunca²,

Atalay³

et al. 2012

Kafkas J Med Sci

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“…1,53 Testing should include baseline cTnl if possible, to exclude occult preexisting infarction, and repeat testing at 6, 12, and 24 hours after operation.…”

Section: Perioperative Groupmentioning

confidence: 99%

“…Herein lies the art of medicine built on a limited science. The purpose of this article is to offer a practice guideline as a complement to my previous review of the diverse elements involved in the clinical application of the biochemical markers of myocardial injury 1 As such, it represents a synthesis of the scientific literature on the subject to facilitate discussion and collaboration among relevant parties, particularly emergency physicians, primary care physicians, cardiologists, and pathologists. The universe of available test selection is enriched by a wide array of improved analytical procedures for quantitating previously established analytes and by the introduction of innovative markers.…”

mentioning

confidence: 99%

The Cardiac Profile and Proposed Practice Guideline for Acute Ischemic Heart Disease

Keffer¹

1997

Am J Clin Pathol

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Presented with an ever-increasing array of potential tests of myocardial injury, the clinical pathologist in conjunction with physicians in primary care, cardiology, and other clinical disciplines must evolve a practical approach for each individual institution. This involves identifying the tests available for immediate (stat) or timed performance, the appropriate patients for whom testing is desired, the schedule of frequency and duration of testing, and the manner in which the test results are to be interpreted. A guideline is presented to address these issues with the purpose of stimulating local adoption of an appropriately modified version to accommodate the current state of the art. Selective choice Applied clinical medicine demands answers to questions that are always incompletely addressed by the clinical literature. Invariably, published studies exclude patients commonly encountered in real practice or raise other questions that have not been adequately addressed by controlled prospective studies. Herein lies the art of medicine built on a limited science. The purpose of this article is to offer a practice guideline as a complement to my previous review of the diverse elements involved in the clinical application of the biochemical markers of myocardial injury 1 As such, it represents a synthesis of the scientific literature on the subject to facilitate discussion and collaboration among relevant parties, particularly emergency physicians, primary care physicians, cardiologists, and pathologists. The universe of available test selection is enriched by a wide array of improved analytical of an early marker, creatine kinase MB by mass immunoassay, in conjunction with cardiac troponin I (cTnl), is proposed as the appropriate combination of laboratory tests that emphasizes the cardiospecificity of cTnl for the variety of applications in which the "cardiac profile" formerly has been used, including the spectrum of clinical settings in which suspected myocardial infarction must be considered. A rationale is provided with emphasis on the relative merit of the various biochemical markers in contrast with other modalities for evaluating suspected myocardial injury.

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“…The early diagnosis of myocardial ischemia and myocardial infarction (MI) is a problem that is not readily solved by the clinical presentation on admission, electrocardiogram (ECG) or routine laboratory tests. Only 15 or 20% of patients presenting to emergency departments eventually have an acute MI, but several thousand are sent home inappropriately each year [2], with the result that 20% of malpractice awards against emergency room physicians are related to a missed diagnosis of MI [3, 4]. Many hospitals admit more than half of the patients presenting with chest pain to the coronary care unit to determine the final diagnosis [3].…”

Section: Introductionmentioning

confidence: 99%

“…Only 15 or 20% of patients presenting to emergency departments eventually have an acute MI, but several thousand are sent home inappropriately each year [2], with the result that 20% of malpractice awards against emergency room physicians are related to a missed diagnosis of MI [3, 4]. Many hospitals admit more than half of the patients presenting with chest pain to the coronary care unit to determine the final diagnosis [3]. The use of hospital resources for this purpose places a serious financial burden on the system and detains many patients who might well be home or at work.…”

Section: Introductionmentioning

confidence: 99%

The Utility of Four Biochemical Markers in the Triage of Chest Pain Patients

Ellestad

Startt-Selvester²,

Stanton³

et al. 2000

Cardiology

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Four biochemical markers, creatine kinase (CK)-MB isoenzyme, myoglobin, myosin light chains and troponin I, were studied in 1,338 patients presenting to the emergency department with chest pain suggestive of coronary artery disease (CAD). One hundred and eighty-seven patients had an acute myocardial infarction (MI). At least one of the four markers was over the threshold on the first sample in 78% of MI patients, as compared to only 40% with an elevated CK-MB. After 4 h, 88% had at least one marker elevated. None of the 69 patients with atypical chest pain, no history of CAD, no markers over threshold on the first sample and a normal electrocardiogram had an acute MI or unstable angina. If we had discharged this group, we would have saved USD 264,000, estimating a cost of USD 2,000 per day. Using four biochemical markers improved the early diagnosis of CAD and may help identify groups suitable for early discharge.

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Myocardial Markers of Injury:Evolution and Insights

Cited by 98 publications

References 84 publications

Comparison of Heart Type Free Fatty Acid Binding Protein, CPK-MB and Troponin-I in the early diagnosis of acute coronary syndrome

Comparison of Heart Type Free Fatty Acid Binding Protein, CPK-MB and Troponin-I in the early diagnosis of acute coronary syndrome

The Cardiac Profile and Proposed Practice Guideline for Acute Ischemic Heart Disease

The Utility of Four Biochemical Markers in the Triage of Chest Pain Patients

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