Sensitivity and Specificity of Troponin T and I for Diagnosis of Acute Myocardial Infarction
| Main Authors: | Samsu, Nur; Brawijaya University, Dr. Saiful Anwar Hospital, Malang, Sargowo, Djanggan; Brawijaya University, Dr. Saiful Anwar Hospital, Malang |
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| Format: | application/pdf eJournal |
| Bahasa: | eng |
| Terbitan: |
Journal of the Indonesian Medical Association
, 2007
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| Online Access: |
http://indonesia.digitaljournals.org/index.php/idnmed/article/view/544 |
Daftar Isi:
- Acute coronary syndrome (ACS) encompasses unstable angina and acute myocardial infarction (AMI). Differentiating ACS from non-cardiac chest pain is a diagnostic challenge. The diagnosis of AMI requires at least two of the following: ischemic symptoms, electrocardiogram (ECG) changes, and serum cardiac marker elevation. However, only 22% of ACS patient present with typical chest pain further more predictive value of the ECG varies markedly. Approximately, AMI is diagnosed in 10% of patients with normal ECG findings and only 41% with “frankly abnormal” ECG findings. Aspartate transaminase, lactate dehydrogenase (LDH), LDH subforms and Creatine kinase (CK) have low sensitivity and specificity for cardiac injury. CK-MB is much more cardiac specific than CK alone, but CK-MB cannot detect minor cardiac injury; its peak level does not predict infarct size and not useful as late markers of recent AMI. Cardiac troponin (cTnT and cTnI) are the preferred markers because of its sensitivity and specificity. They can detect microinfarction, will remain elevated up to two weeks after symptom onset (useful as late markers of recent AMI) and helpful in risk stratification of ACS. Raised troponin levels are associated with increased risks of death and development of AMI and showed greater treatment benefit with LMWH, IIb/IIIa antagonists and revascularization. Increased risk is related quantitatively to the serum troponin level. Generally, troponin T or I is the most sensitive determinant of ACS.Keywords: Acute Coronary Syndrome, Cardiac Marker, Troponin