Troponin - Reliable Indicator of Future Heart Attack

Duke University Medical Center cardiologists have recently discovered that troponin, a specific biochemical marker of heart cell death, indicates future risk of heart attack even when the other traditional indicators are negative.

Risk of heart attack is usually indicated by chest pain and electrocardiogram abnormalities; when physicians look for chemicals in the blood that indicate damaged or dead heart muscle, they usually measure the levels of creatine kinase-MB (CK-MB), and only more recently, of troponin. Both compounds are proteins released into the blood stream after the cell wall breaks during heart cell death, with the difference that CK-MB is also released during deterioration/death of skeletal muscle cells.

Both low-risk and high-risk patients, from three different multi-center trials, were included in the study and divided into three groups: those who were positive for troponin only, those who were positive for CK-MB and those positive for both troponin and CK-MB. The researchers found the same incidence of death or heart attack after 30 days for patients who only tested positive on the troponin test as for those who tested positive on both. Thus, it was concluded that the same emphasis should be placed in treating patients with only troponin elevation as on those with elevations of both markers.

The test for troponin can detect even small amounts of damage - tiny heart attacks or infarctlets. What is left to establish is to what extent is the death of a few heart cells a predictor of larger infarctions.

Patients testing positive for troponin were usually described as low-risk, and the importance of the findings of the Duke team resides precisely in the fact that it draws attention upon the fact that these are actually at a higher risk of cardiac events than previously thought. Any elevation of cardiac markers means risk, and Duke cardiologists even argue that troponin levels should be used instead of CK-MB to detect risk of future heart attack.

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