Analytical Issues Surrounding Troponin Assays

Is CK-MB Needed Anymore?

October 2010

The question often arises if CK-MB is even needed anymore. It is well recognized and accepted that it does not provide any additional information over troponin even in the setting of suspected re-infarction (which is rare today), assessing infarct size, before or after percutaneous coronary intervention, or in end stage renal disease patients. The only time CK-MB should be ordered is if there are suspicious false-positive troponin T or I results (although these can usually be resolved with heterophile blocking tubes or dilution studies) or if troponin testing is simply unavailable. Medicare does not reimburse troponin and CK-MB testing performed simultaneously.

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Jump to section:

• Introduction
• Challenges in Cardiovascular Medicine
• Shades of Gray
• Cardiac Markers
• Troponin Elevations are Greater and Persist Over Longer Time Periods
• 2007 Universal Definition of MI1
• Serial Sampling
• Elevation of cTn in Patients Without Overt Ischemic Heart Disease¹
• Analytic Confusion: Sensitivity and Imprecision of cTn Assays
• Analytical Definitions (Related to Troponin)
• Current Troponin Assays
• Defining the 99th Percentile (Normal Population)
• Troponin T or Troponin I: Does it Matter?
• Is CK-MB Needed Anymore?
• Recommendations for Point-of-Care Cardiac Marker Testing^2,3
• Does POCT Make Any Difference?
• What About the High-Sensitive Troponin Assays?
• Why All the Hype for High-Sensitivity Troponin?
• Troponin Concentrations and Diagnostic Accuracy⁴
• How Sensitive Does Troponin Testing Really Need to Be?
• Current Mayo Cardiac Biomarker Panel
• Current Mayo Cardiac Biomarker Panel
• Conclusions
• References
• Questions?
• Disclosure