NEW MARKERS FOR EARLY DIAGNOSIS OF ACUTE MYOCARDIAL-INFARCTION

The availability of 'new' biochemical markers of myocardial injury suc h as creatine kinase isoforms and troponins has renewed the interest f or rapid confirmation/exclusion of myocardial infarction in patients p resented to the hospital for suspected acute myocardial ischemia. Many of these protein markers have the potential to allow the diagnosis of acute myocardial infarction at a time from the onset of symptoms when the activity of creatine kinase MB is still within the reference rang e. However, the exclusion of classical myocardial infarction as define d by WHO criteria does not allow to conclude that the patient is at lo w-risk and can be safely sent home since he may have high-risk unstabl e angina. The sensitivity for the detection of myocardial damage of tr oponins is such that a substantial proportion of patients with unstabl e angina develop elevations of troponins in the absence of creatine ki nase MB increases. It is now clear that such patients have an increase d risk of cardiac events over the short and long-term similar to that of patients with definite myocardial infarction. Such finding may help in developing selective admission policies and deciding which patient s deserve aggressive treatment. (C) 1998 Elsevier Science Ireland Ltd.