(Circulation. 2000;102:1216.)
© 2000 American Heart Association, Inc.
Editorial |
It’s Time for a Change to a Troponin Standard
From the Mayo Clinic, Rochester, Minn (A.S.J.); Aalborg University Hospital, Aalborg, Denmark (J.R.); Baylor College of Medicine, Houston, Tex (R.R.); Norrland University Hospital, Umea, Sweden (U.N.); Hennepin County Medical Center and the University of Minnesota, Minneapolis (F.S.A.); Ospedale G.B. Morgagni and Fondazione Cardiologica Sacco, Forlì, Italy (M.G.); and Universitat zu Lubeck, Lubeck, Germany (H.K.).
Correspondence Allan S. Jaffe, MD, 16th Floor, Mayo Building, 200 First Street SW, Rochester, MN 55905. E-mail Jaffe.Allan@mayo.edu
Key Words: Editorials • troponin • myocardial infarction • coronary disease
Recently, the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) convened a conference to discuss refinements in the diagnosis of acute myocardial infarction. The panel on biochemistry considered issues related to the use of marker proteins. We were guided predominantly by the science of the area. We were also cognizant of the impact that changes in the standards would have on epidemiology, clinical trials, education of physicians, and patient care. Our recommendations will be incorporated, with the recommendations of the other panels, into a position paper for the ESC and the ACC. However, the members of the biochemistry group decided to express the opinions we felt were important in this area independently. Our thinking does not represent the position of the ESC, the ACC, or of the conjoint task force.
Many modifications of the original World Health Organization criteria
for acute myocardial infarction1 have been accepted and
incorporated into the ESC/ACC criteria; some deletions have also
occurred. Until recently, most markers were detected using enzymatic
activity; detection of the protein concentration now is preferred.
Thus, it is more appropriate to refer to molecules released into the
circulation as a consequence of cardiac injury as biochemical
diagnostic markers or biomarkers. In this editorial, we
emphasize issues related to the biochemical diagnosis of acute
myocardial infarction. New and improved plasma biomarkers (troponins)
with better sensitivity and specificity will be emphasized in
preference to markers such as total creatine kinase (CK), CK-MB,
lactate dehydrogenase, and aspartate aminotransferase. Rapid assays
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