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Markers of myocardial damage
Last reviewed: 04.07.2025
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Myocardial infarction is an acute disease that occurs as a result of a sharp discrepancy between the myocardium's need for oxygen and its delivery through the coronary arteries, ending in the development of necrosis of part of the heart muscle.
It is currently considered proven that the cause of myocardial infarction in more than 80% of cases is intracoronary thrombosis, which usually occurs at the site of an atherosclerotic plaque with a damaged surface.
Myocardial infarction is a dynamic process that develops both in time and space. As a result of defects that occur in the cytoplasmic membranes of myocardiocytes, proteins and enzymes localized in the cytoplasm enter the patient's blood at a rate that depends primarily on the size of their molecules.
Over the past two decades, numerous randomized trials have been conducted to evaluate the efficacy and safety of myocardial infarction diagnostics and treatment. The results of the studies have formed the basis for guidelines for the management of patients with myocardial infarction. In 2000, a joint document of the European Society of Cardiology (ESO) and the American College of Cardiology (ACC) was published.
The above clinical guidelines indicate that cardiac troponins T and I have almost absolute specificity for myocardial tissue, as well as high sensitivity, which allows detecting even microscopic areas of myocardial damage. The use of troponin testing for the diagnosis of myocardial infarction is a Class I recommendation. Cardiac troponins should be determined upon admission and again after 6-12 hours. If the test results are negative and the risk of myocardial infarction is high according to clinical data, the test is repeated after 12-24 hours. In the case of a repeated myocardial infarction, troponin concentrations are determined 4-6 hours after the onset of the relapse and then again after 6-12 hours.
Serum myoglobin activity and/or CK-MB activity should be measured in patients with recent (<6 h) onset of clinical symptoms and in patients with recurrent ischemia after a recent (<2 weeks) myocardial infarction to detect recurrence. In the case of recurrent myocardial infarction, the importance of myoglobin and CK-MB testing increases because troponin levels may still be elevated due to the initial episode of myocardial necrosis.
Patients with chest pain and troponin T/I concentrations above the upper limit of the reference value are considered to have “myocardial injury” (requiring hospitalization and close monitoring).
Clinical guidelines clearly indicate that the study of the activity of AST, LDH and its isoenzymes should not be used to diagnose myocardial infarction.
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