Rational diagnostic strategy in diagnosis of ischemic myocardial injury. S-troponin T and S-CK MB (mass) time series using individual baseline values.
The new and sensitive serum markers S-troponin T and S-CK MB (mass) can detect minor myocardial damage (MMD) in patients after an episode of acute myocardial ischemia even when accepted criteria for a myocardial infarction are not fulfilled. High-risk MMD patients constitute about one-third of unstable angina pectoris cases. Since 1989 we have compared S-troponin T and S-CK MB (mass concentration) with catalytic S-CK and S-CK MB determinations in several studies comprising more than 600 patients. We conclude that the combination of the two most cardiospecific and sensitive markers, S-troponin T + S-CK MB (mass), is highly informative in studies and evaluations. If only one marker can be routinely used, S-troponin T may replace current tests. Rational utilization of S-troponin T and S-CK MB (mass) requires an adequate number of determinations within the respective diagnostic time windows using a sampling time schedule relating to time of onset pain in each patient. Individual reference values of each marker may easily be obtained by taking baseline samples in a stable phase, e.g. during convalescence. The data are best understood when they are presented as time series in graphic laboratory reports. The relative increases of the myocardial markers are three to five-fold higher when they are plotted relative to the individual baseline value of each patient than when they are plotted against the respective, general discriminator values for infarction.