Lack of utility of CK-MB in combination with troponin I for the diagnosis of acute coronary syndrome
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CE-RESEARCH LETTER TO THE EDITOR
Lack of utility of CK‑MB in combination with troponin I for the diagnosis of acute coronary syndrome Silvia Baroni1 · Maurizio Gabrielli2 · Federica Ferrigno2 · Francesco Franceschi2 · Andrea Urbani1 Received: 2 May 2020 / Accepted: 3 June 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Keywords CK-MB · Troponin I Ultra · Acute myocardial infarction Dear Editor, Cardiac troponins replaced Creatine kinase-MB (CK-MB) as the diagnostic biomarker for acute coronary syndromes (ACS) since their significantly higher sensitivity and specificity [1, 2]. In addition cardiac troponins are endowed with stronger prognostic information [3, 4]. For these reasons either European or American guidelines state that CK-MB provides no additional value for diagnosing acute myocardial infarction (AMI) [1, 2.]. Despite the availability of literature data and international guidelines, CK-MB is still often ordered in combination with troponin in many hospitals around the world, perhaps because many physicians are convinced of a CK-MB’s clinical utility in certain settings, such as renal failure or reinfarction, or they think that troponins are either highly sensible or poorly specific [5]. Our aim was to review the combined orders of troponin I and CK-MB in our hospital, the Fondazione Policlinico Universitario Agostino Gemelli—IRCCS, an academic tertiary centre and one of major hospitals in Rome, Italy, with a capacity of 1558 beds and about 85,000 visits during the 2018 at the Emergency Department. We aimed to review the volume of combined orders of the troponin in use in our centre (I-Ultra) and CK-MB, and to
* Silvia Baroni [email protected] 1
Department of Basic Biotechnological Sciences, Intensivological and Perioperative Clinics, UOC of Clinical Chemistry, Biochemistry and Molecular Biology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
2
assess the utility of this combination for the final diagnosis of acute myocardial infarction (AMI). We retrospectively analysed all the simultaneous orders for troponin and CKMB received by the laboratory of Clinical Chemistry of our hospital during a 12 months period (from March 2018 to March 2019). The troponin tested in our laboratory is the troponin I-Ultra Advia Centaur (Siemens Healthcare Diagnostics, USA), by a CLIA method and with a 99th percentile reference limit of 0.040 ng/ml. The CK-MB is measured by a CLIA method (Siemens Healthcare Diagnostics, USA), with a 99th percentile reference limit of 7 and of 4 ng/ml in men and in women, respectively, for CK-MB. The reference ranges for total CK, measured by an enzymatic method (Siemens Healthcare Diagnostics, USA) is 30–170 U/L in men and 30–145 U/L in women. Doctors of our hospital have a free choice to send orders for troponin I or CK-MB or both. We considered specimens in which the
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