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Discordant creatine kinase and cardiac troponin T in the workup of acute coronary syndrome

Published online by Cambridge University Press:  21 May 2015

Jamil Kanji  and
Jerome Fan
Jamil Kanji
Affiliation:
Department of Internal Medicine, McMaster University, Hamilton, Ont.
Jerome Fan*
Affiliation:
Division of Emergency Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont.
*
Division of Emergency Medicine, McMaster University, 50 Charlton Ave. E., St. Joseph's Healthcare, Hamilton ON L8N 4A6; [email protected]

Abstract

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A 55-year-old man presented to the emergency department (ED) following 2 episodes of typical cardiac chest pain and nonspecific electrocardiogram findings. His serial cardiac marker assays revealed an elevated total creatine kinase (CK) and 2 negative cardiac troponin levels. Because of a high clinical suspicion of acute coronary syndrome, a total creatine kinase MB mass was obtained and found to be elevated. Subsequent cardiac angiography demonstrated a significantly flow-limiting coronary artery lesion, and stenting was performed. This case demonstrates that simultaneous CK and troponin measurements may have utility in selected ED patients with chest pain. The interpretation of discordant CK and troponin levels is discussed.

Résumé

RÉSUMÉ

Un homme de 55 ans s’est présenté à l’urgence après 2 épisodes de douleurs thoraciques cardiaques et des résultats d’électrocardiogramme non spécifiques. Le dosage en série de marqueurs cardiaques a révélé un taux élevé de créatine kinase totale (CK) et 2 résultats négatifs pour la troponine cardiaque. En raison d’une forte suspicion clinique de syndrome coronarien aigu, on a fait le dosage de la créatine kinase MB masse, et les taux ont été jugés élevés. Une angiographie cardiaque subséquente a révélé une lésion de l’artère coronarienne limitant le flux de façon significative, et un tuteur a été posé. Ce cas illustre que le dosage simultané de la CK et de la troponine peut être utile chez certains patients se présentant à l’urgence avec des douleurs thoraciques. Cet article discute l’interprétation des taux discordants de CK et de troponine.

Keywords

myocardial infarctiontroponincreatine kinasediagnostic testing
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 1 , January 2010 , pp. 64 - 68
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

REFERENCES

1. Apple, FS, Smith, SW, Pearce, LA, et al. Assessment of the multiple-biomarker approach for the diagnosis of myocardial infarction in patients presenting with symptoms suggestive of acute coronary syndrome. Clin Chem 2009;55:93–100.Google Scholar
2. Saiki, A, Iwase, M, Takeichi, Y, et al. Diversity of the elevation of serum cardiac troponin I levels in patients during their first visit to the emergency room. Circ J 2007;71:1458–62.Google Scholar
3. McCann, CJ, Glover, BM, Menown, IBA, et al. Novel biomarkers in early diagnosis of acute myocardial infarction compared with cardiac troponin T. Eur Heart J 2008;29:2843–50.Google Scholar
4. Thygesen, K, Alpert, JS, White, HD, et al. Universal definition of myocardial infarction. Circulation 2007;116:2634–53.Google Scholar
5. Storrow, AB, Lindsell, CJ, Han, JH, et al. Discordant cardiac biomarkers: frequency and outcomes in emergency department patients with chest pain. Ann Emerg Med 2006;48:660–5.Google Scholar
6. Yee, KC, Mukherjee, D, Smith, DE, et al. Prognostic significance of an elevated creatine kinase in the absence of an elevated troponin I during an acute coronary syndrome. Am J Cardiol 2003;92:1442–4.Google Scholar
7. Newby, LK, Roe, MT, Chen, AY, et al. Frequency and clinical implications of discordant creatine kinase-MB and troponin measurements in acute coronary syndromes. J Am Coll Cardiol 2006;47:312–8.Google Scholar
8. Hamm, CW, Goldmann, BU, Heeschen, C, et al. Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med 1997;337:1648–53.Google Scholar
9. Tucker, JF, Collins, RA, Anderson, AJ, et al. Early diagnostic efficiency of cardiac troponin I and troponin T for acute myocardial infarction. Acad Emerg Med 1997;4:13–21.Google Scholar
10. Storrow, AB, Lindsell, CJ, Han, JH, et al. Discordant cardiac biomarkers: frequency and outcomes in emergency department patients with chest pain. Ann Emerg Med 2006;48:660–5.Google Scholar
11. Tonino, PAL, De Bruyne, B, Pijls, NHJ, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009;360:213–24.Google Scholar
12. Kramer, JM, Newby, LK, Chang, W-C, et al. International variation in the use of evidence-based medicines for acute coronary syndrome. Eur Heart J 2003;24:2133–41.Google Scholar