Why all the struggle about CK-MB and PCI?

Abstract

Cardiovascular medicine has, in general, enthusiastically embraced new technologies and used them per appropriate guidelines. However, one area in which this has not been as much the case has been with cardiac troponin (cTn). There has been reluctance to use cTn at the suggested 99th percentile of the upper reference range (URL).1 Part of this reluctance reflects a lack of comfort with the large number of increases seen with such a sensitive probe that challenge clinicians.2 However, the reluctance to utilize cTn properly has distorted the utility of cTn in many areas,1,2 but perhaps it has caused the greatest confusion in the area of post-PCI biomarker increases as attested to by recent articles.3–5 In this area, the reluctance to give up the paradigms of the past and to use cTn per guidelines has led to confusion and inaccurate conclusions in articles published even in our most prestigious journals. This editorial from a group of researchers knowledgeable in this area attempts to articulate some of the difficulties with the interpretations thus far posed and suggest how proper use of cTn can achieve a better understanding in this important area. It does not and cannot answer all of the questions going forward but progress is only possible if we understand and properly interpret the data that presently exist. A recent article in this area published in JACC3 is an excellent example of the problems in this area. It was followed by an editorial that misconstrues most of the important concepts.4 The article utilized MR imaging post-PCI to visualize areas of cardiac injury putatively related to the procedure. Because they used a good and sensitive cTn assay and the recommended cut-off values, they found that more increases in CK-MB were associated findings of …