A Nail in the Coffin of Troponin Measurements After Percutaneous Coronary Intervention

Over the past several decades, we have made substantial progress in the early diagnosis and management of acute myocardial infarction (AMI). Throughout most of our careers, the diagnosis of AMI required that at least 2 of 3 criteria were met: prolonged ischemic symptoms, diagnostic electrocardiographic (ECG) changes, and elevation of total creatine kinase (CK) with creatine kinase-myocardial band (CK-MB) exceeding 3 times the upper limit of normal. Over the past several decades, these diagnostic criteria were repeatedly validated with evidence showing that the level of CK-MB was highly predictive of infarct size, development of heart failure, as well as short- and long-term mortality. Given these findings, why have many hospitals abandoned measurement of CK-MB in favor of troponin?