When you suspect ACS, which serologic marker is best?
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Measurement of troponin levels provides the most sensitive and accurate serologic information in evaluating a patient with acute coronary syndrome (ACS); troponin elevations are more sensitive than elevations of creatine kinase-MB (CK-MB). Isolated elevation of troponin levels increases the likelihood of myocardial infarction (MI) or death, whereas isolated elevation of CK-MB levels doesn't. (Strength of recommendation [SOR] for all statements: A, multiple, large prospective cohort studies.) Repeated measurement of troponin levels at presentation and then 3 and 6 hours afterward increases the diagnostic sensitivity for acute myocardial infarction (AMI) (SOR: A, multiple, small prospective studies).
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