MYOCARDIAL MARKERS OF INJURY - EVOLUTION AND INSIGHTS

Knowledge of the pathophysiology of ischemic heart disease has advance d in parallel with awareness of the significant limitations inherent i n clinical assessment. Biochemical assays, long established as the mos t reliable means of detecting myocardial injury; have improved signifi cantly. Creatine kinase MB, now optimally measured by the newer mass m onoclonal antibody assays, and also measurement of the cardiac troponi ns objectively identify adverse prognosis. Cardiac troponin I appears to have significant advantages over other markers and may be come the assay of choice. This is attributable to the confirmation of cardiospe cificity claims regarding this marker. These assays permit increased a ppreciation of the continuous spectrum of ischemic myocardial injury, earlier diagnosis, refinement of the clinical assessment of risk, and evaluation of alternative treatment regimens. Reassessment of the inco rporation of biochemical indicators for thrombolytic therapy can be an ticipated. This paper integrates the clinical and biochemical literatu re in reviewing these concepts.