Acute cardiovascular disease is one of the main causes of admission to emergency services. In this regard, a group of experts ensures that the elimination of CK-MB, or creatine kinase-MB, can save millions of dollars in medical care without adversely affecting the patient’s performance. As one of the main causes of admission to emergency services, the clinical description and the electrocardiogram are essential when diagnosing acute cardiovascular disease. However, when these do not provide significant data, the biochemical parameters must be analyzed to differentiate it from other entities.
Cardiac biomarkers
have an important place in medical practice in the evaluation of acute myocardial infarction, are considered as molecules, proteins or enzymes measurable in plasma, which provide an independent diagnostic and prognostic value that reflects a state of disease or underlying disorder. Until a decade ago, the measurement of the biological markers of myocardial necrosis was limited to the assessment of the catalytic activity of total creatine kinase (CK) or that of its more cardiospecific isoenzyme, creatine kinase MB (CK-MB). However, neither of these two classical markers adequately satisfies the diagnostic specificity that new clinical needs have required over time.
What is the cardiac biomarker of choice?
Cardiac Troponin is the biomarker of choice recommended by the American College of Cardiology and the European Society of Cardiology. Its almost absolute specificity in cardiac tissue and high sensitivity in myocardial damage, do not contemplate under any circumstances the use of CK-MB. Cardiac troponins are released in response to cardiac myocyte necrosis.
In a Special Communication published in the Journal of the American Medical Association (JAMA) in October 2017, experts Matthew D. Alvin, Allan S. Jaffe and Roy C. Ziegelstein agreed that the elimination of creatine kinase-MB, can lead to savings of millions of dollars in medical care without negatively affecting the patient’s finances.
“Troponin is the determination that is usually asked to rule out heart attack patients who come with chest pain,” explains Dr. Allan Jaffe, Director of the Division of Laboratory Services in the Department of Laboratory Medicine at the Clinic May, in Minnesota, United States. And he adds: “Troponin has a high, even, one could say almost perfect specificity for heart damage.”
Experts point out that: “CK-MB is a lower biomarker, less sensitive, less specific and there is no particular circumstance in which it has greater utility.” According to Dr. Jaffe, CK-MB does not add any value to being ordered together with troponin, on the contrary, it increases the cost and, what is more important, it can generate confusion among physicians in the interpretation of the result.
Despite the evidence that holds troponin as the ideal marker, CK-MB has not yet been eliminated from practice. As a final comment, Dr. Jaffe states that if there is no alternative but to quantify creatine kinase, the preferred option is the MB mass creatine kinase (CK-MB mass) assay, which is more sensitive than the activity assay and is equivalent to of troponin. Make sure you can replace it. In this scenario, the biggest obstacle is convincing the doctors, who have ordered CK-MB for years, to change their order. For the elimination of CK-MB to be successful, laboratory professionals will have an essential role, informing that safety and efficacy in diagnosis are not compromised when they stop using this practice.
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