Rationale and Comments

According to published guidelines, cardiac troponin is the lab test of choice to diagnose acute coronary syndrome or acute myocardial infarction. Troponin is highly sensitive for acute myocardial infarction and more specific than CK-MB; CK-MB yields no incremental diagnostic value even in patients with chronic kidney disease. Guidelines also support the use of cardiac troponin over CK-MB for diagnosing reinfarction.

Sponsoring Organizations

• Society of Hospital Medicine – Adult Hospital Medicine

Sources

• ACCF/AHA guidelines

Disciplines

• Cardiovascular

References

• Anderson JL, Adams CD, Antman EM, et al. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines [published correction appears in J Am Coll Cardiol. 2013;62(11):1040-1]. J Am Coll Cardiol. 2013;61(23):e179-e347.
• O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):e78-e140.
• Amsterdam EA, Wenger NK Brindis RG, et al. American College of Cardiology American Heart Association Task Force on Practice Guidelines: Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons; American Association for Clinical Chemistry. 2014 AHAACC Guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(24):e139-e228.
• Alvin MD, Jaffe AS, Ziegelstein RC, et al. Eliminating creatine kinase-myocardial band testing in suspected acute coronary syndrome: a value-based quality improvement [published correction appears in JAMA Intern Med. 2017;177(10):1544]. JAMA Intern Med. 2017;177(10):1508-1512.
• Thygesen K, Alpert JS, White HD, et al. Universal definition of myocardial infarction. Circulation. 2007;116(22):2634-2653.
• Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation. 2012;126(16):2020-2035.