The use of biochemical markers in ischaemic heart disease: summary of the roundtable and extrapolations.
Acceptable biochemical markers of ischaemic heart disease are now considered to include myoglobin, CK-MB isoforms, CK-MB, and cardiac troponins T and I. AST (SGOT), total LD and LD isoenzymes, and total CK activity measurements are regarded as obsolete for this purpose. All acceptable biochemical markers must be available, if required, with a turnaround time of < 20 min. Such a service can either be provided by quantitative assays in a well-equipped laboratory or by qualitative point-of-care (bedside) devices (except for the CK-MB isoform assay) which can also be used in patients' homes and ambulances. There is, however, a pressing need for the careful side-by-side assessment of the relative merits of each of these biochemical markers to permit definitive conclusions about their future usage. A particular problem is the lack of primary standards for CK-MB and troponin I assays. The sensitivity of the initial ECG is about 50% for detecting myocardial damage; thus the use of biochemical markers may contribute to the early diagnosis and monitoring of thrombolytic therapy and these possible applications are examined. In addition, biochemical markers are presently the gold standard for the diagnosis of minor myocardial damage. There is now good evidence that biochemical markers, particularly the cardiac troponins, have a prognostic function in ischaemic heart disease although such findings pose unanswered clinical management questions. At the same time, it is recognized that there is often no need at all for the use of any biochemical marker when the clinical diagnosis is unequivocal, other than for prognosis, monitoring thrombolytic therapy, or diagnosing reinfarction.
Henderson
A R
AR
Department of Biochemistry, University of Western Ontario, London, Canada. ahenders@julian.uwo.ca
Gerhardt
W
W
Apple
F S
FS
D015415:Biomarkers; D003402:Creatine Kinase / Q000097:blood; D006801:Humans; D007527:Isoenzymes; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D009211:Myoglobin / Q000097:blood; D015912:Thrombolytic Therapy; D014336:Troponin / Q000097:blood; D019210:Troponin I / Q000097:blood; D020107:Troponin T
D015415:Biomarkers; D007527:Isoenzymes; D009211:Myoglobin; D014336:Troponin; D019210:Troponin I; D020107:Troponin T; D003402:Creatine Kinase