STEMI Reinfarction (CK-MB vs Tn)

[seminoma]

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Just read on uptodate that troponin is now preferred in diagnosis of reinfarction. I think this is pretty interesting especially since we've all been taught CK-MB is the best because of the short duration of elevation.

Anyone encounter this on the wards? I'm curious if this will pop up on shelf exams/2CK.

 

[Instatewaiter]

Just read on uptodate that troponin is now preferred in diagnosis of reinfarction. I think this is pretty interesting especially since we've all been taught CK-MB is the best because of the short duration of elevation.

Anyone encounter this on the wards? I'm curious if this will pop up on shelf exams/2CK.

With a STEMI, reinfarction is not subtle. With acute stent thrombosis, you usally ahve ST elevation again.

For NSTEMI, pathophysiologically either would be fine- Tn and MB. If you are concerned about reinfarction only a few hours after PCI both would likely be rising still. So within 6 hours or so, clinical status and symptoms would determine if you take them back to the lab. Otherwise either could be used. We often send both.

 

[MedTRON]

how about if its a trauma or a high stressed situation. would these tests be reliable?

 

[tiedyeddog]

CKMB would be less useful in a trauma. CKMB has been known to elevate in the setting of peripheral muscle damage confusing the traumatic injury from cardiac ischemia.

 

[Cytarabine]

CKMB would be less useful in a trauma. CKMB has been known to elevate in the setting of peripheral muscle damage confusing the traumatic injury from cardiac ischemia.

Chest trauma can spike trops as well to my recollection; any significant cardiac stress for that matter, e.g. running a marathon. Read an article on nonischemic etiologies of elevated trops a few months ago and seem to recall emphasis being placed on clinical picture + trop trend more so than absolute level

 

[MedTRON]

CKMB would be less useful in a trauma. CKMB has been known to elevate in the setting of peripheral muscle damage confusing the traumatic injury from cardiac ischemia.

thanks for the explanation. that came up on my cardiac test.

 

[Instatewaiter]

CKMB would be less useful in a trauma. CKMB has been known to elevate in the setting of peripheral muscle damage confusing the traumatic injury from cardiac ischemia.

Part of the reason MB percent is also used. Usually in non-specific muscle damage your MB will be high and percent will be normal.

That said, You can get MB from tongue, intestine/stomach damage as well. Sometimes you'll see it in patients with UC flares and the like where both MB and percent will be high but usually troponin will be normal.

 

[tiedyeddog]

Part of the reason MB percent is also used. Usually in non-specific muscle damage your MB will be high and percent will be normal.

That said, You can get MB from tongue, intestine/stomach damage as well. Sometimes you'll see it in patients with UC flares and the like where both MB and percent will be high but usually troponin will be normal.

I am assuming other institutions aren't like this but at mine we can't order any form of CKMB. Our lab told me we can only do trop onions and they based this decision off if the latest aca/aha guidelines...

 

[gmbz]

I see more CPK usage with statin therapy than with ischemia.

 

[univlad]

I think many labs are starting not to offer CK-MB any longer.