Abstract
Background
Despite differing underlying pathophysiology, type 1 and type 2 myocardial infarction
share many of the same diagnostic criteria and can be challenging to differentiate
in clinical practice. Correctly differentiating type 1 from type 2 myocardial infarction
is important because they are managed differently. The aim of this study was to compare
the patterns of rise of cardiac troponin (cTn) and creatine kinase MB (CK-MB) in type
1 and type 2 myocardial infarction.
Methods
We analyzed retrospective data on 200 patients with myocardial infarction (97 with
type 1, 103 with type 2), excluding patients with ST-segment elevation myocardial
infarction. The percentage rise from trough to peak values and the ratio of the peak
to the upper limit of normal (RULN) were calculated for both cardiac troponin T (cTnT)
and CK-MB. The ratio of peak cTnT to peak CK-MB was also calculated before and after
adjusting for sex, glomerular filtration rate (GFR), and infarct size.
Results
Type 1 myocardial infarction tended to be larger than type 2 myocardial infarction,
with a significantly higher mean percentage rise for both cTnT and CK-MB as well as
higher mean RULN (207 vs 86 for cTnT, P = 0.02; 9 vs 4 for CK-MB, P = 0.002). There was a trend toward a higher rise of cTnT than CK-MB in type 2 compared
with type 1 myocardial infarction, as demonstrated by the ratio of peak cTnT to peak
CK-MB (0.09 in type 2 myocardial infarction vs 0.06 in type 1 myocardial infarction,
P = 0.06). This difference persisted after adjusting for sex, GFR, and infarct size
(P = 0.05).
Conclusion
Both cTnT and CK-MB rise higher in type 1 than in type 2 myocardial infarction. Meanwhile,
cTnT tends to rise out of proportion to CK-MB in type 2 myocardial infarction. These
patterns may have considerable implications for the differentiation and subsequent
treatment of patients with type 1 versus type 2 myocardial infarction.
Keywords
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Article Info
Publication History
Published online: March 29, 2020
Footnotes
Funding: None.
Conflicts of Interest: LBD reports consulting fees from Roche Diagnostics and Quidel and has served on clinical endpoints adjudication committees for Siemens and Abbott. AKP, TD, IS report none.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
