Troponin I/myoglobin/creatine kinase isoenzyme (cTnI/MYO/CK-MB) includes the detection of the following three indicators: troponin I (cTnI), myoglobin (MYO), creatine kinase Isoenzyme (CK-MB), the combined detection of these three items is of great significance in the early diagnosis of acute myocardial infarction (AMI) and other acute myocardial diseases.
National Academy of Clinical Biochemical Sciences (NACB) Practice Guidelines
All patients with suspected ACS should be tested for myocardial necrosis markers
Troponin is the first choice marker for the diagnosis of myocardial infarction
The combined application of myoglobin and specific myocardial necrosis markers (such as cTnI/CK-MB) helps to rule out or diagnose myocardial infarction more quickly
MYO | CK-MB | cTnI | |
molecular weight | 17.8KD | 86KD | 22.5KD |
Rise time | 1-2h | 4-6h | 3-6h |
Peak time | 6-9h | 24h | 12-16h |
recovery time | 18-30h | 2-3d | 4-10d |
Clinical value | 1.The most important indicator of early AMI exclusion 2. Diagnosis of AMI recurrence, the best index for evaluating the effect of reperfusion treatment | 1.Estimate the size of the infarct or re-infarction 2. The most valuable markers of MI without ST-segment elevation | 1.The first choice marker for AMI diagnosis 2. Judge the infarct size and carry out risk stratification |
Possibility of outcome | |||
cTnI | CK-MB | MYO | Clinical possibility |
+ | + | + | It can basically diagnose myocardial infarction/myocardial injury, and the occurrence time is within 12-24 hours; |
+ | + | - | It can basically be diagnosed as myocardial infarction/myocardial injury, the detection time is more than 1 day, and the detection window of MYO has passed |
+ | - | - | Myocardial infarction/myocardial injury has been onset for 2-3 days, and it is recommended to review after a few hours; |
+ | - | + | In patients with myocardial infarction/myocardial injury, the detection time may exceed 3 days for symptoms, and the patient has re-injury or enlarged infarct size; |
- | + | + | Early myocardial infarction/myocardial injury/muscle injury, it is recommended to review cTnI within 4-8 hours; |
- | - | + | 1. Early myocardial infarction/myocardial injury, it is recommended to review cTnI within 4-8 hours; |
2. It may be caused by other injury diseases, such as creation, skeletal muscle injury, liver and kidney disease; | |||
- | + | - | 1. For minor myocardial damage, it is recommended to review cTnI within 4-8 hours; |
2. It may be a non-myocardial injury disease, and the detection time has passed the MYO window period; | |||
- | - | - | Myocardial infarction/myocardial injury is basically ruled out. If it is highly suspected, it is recommended to review every 2-4 hours. |
Detection range | sample size | Sample type | Test time | ||
cTnI | MYO | CK-MB | 60μl | Whole blood / serum / plasma | 15min |
0.1~50ng/mL | 10~200ng/mL | 0.8~100ng/mL |
Outpatient, emergency, physical examination center, cardiovascular, ICU, chest pain center and other departments
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