A Comparison of Biomarker Rise in Type 1 and Type 2 Myocardial Infarction

Amit K Pandey; Thao Duong; Iwona Swiatkiewicz; Lori B Daniels

doi:10.1016/j.amjmed.2020.02.024

A Comparison of Biomarker Rise in Type 1 and Type 2 Myocardial Infarction

Am J Med. 2020 Oct;133(10):1203-1208. doi: 10.1016/j.amjmed.2020.02.024. Epub 2020 Mar 29.

Authors

Amit K Pandey¹, Thao Duong², Iwona Swiatkiewicz³, Lori B Daniels⁴

Affiliations

¹ Division of Internal Medicine; University of California San Diego, La Jolla, CA.
² Division of Cardiovascular Medicine; University of California San Diego, La Jolla, CA.
³ Division of Cardiovascular Medicine; University of California San Diego, La Jolla, CA; Department of Cardiology and Internal Medicine; Collegium Medicum, Nicolaus Copernicus University; Bydgoszcz, Poland.
⁴ Division of Cardiovascular Medicine; University of California San Diego, La Jolla, CA. Electronic address: lbdaniels@ucsd.edu.

PMID: 32234496
DOI: 10.1016/j.amjmed.2020.02.024

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: Cardiac troponin; Creatine kinase MB; Type 1 myocardial infarction; Type 2 myocardial infarction.

Publication types

Comparative Study

MeSH terms

Aged
Aged, 80 and over
Biomarkers / blood
Creatine Kinase, MB Form / blood*
Female
Humans
Male
Middle Aged
Myocardial Infarction / blood*
Myocardial Infarction / classification
Troponin T / blood*

Substances

Biomarkers
Troponin T
Creatine Kinase, MB Form