Myocardial markers of injury. Evolution and insights.

Knowledge of the pathophysiology of ischemic heart disease has advanced in parallel with awareness of the significant limitations inherent in clinical assessment. Biochemical assays, long established as the most reliable means of detecting myocardial injury, have improved significantly. Creatine kinase MB, now optimally measured by the newer mass monoclonal antibody assays, and also measurement of the cardiac troponins objectively identify adverse prognosis. Cardiac troponin I appears to have significant advantages over other markers and may become the assay of choice. This is attributable to the confirmation of cardiospecificity claims regarding this marker. These assays permit increased appreciation of the continuous spectrum of ischemic myocardial injury, earlier diagnosis, refinement of the clinical assessment of risk, and evaluation of alternative treatment regimens. Reassessment of the incorporation of biochemical indicators for thrombolytic therapy can be anticipated. This paper integrates the clinical and biochemical literature in reviewing these concepts.