Table 6.

Role of Biomarker Testing in STEMI.

Indications for Troponin Testing

•Early Troponin testing to guide reperfusion

Asymptomatic ECG changes

Non diagnostic ECG changes

Presumably new onset LBBB without fulfilling STEMI criteria

Paced rhythm

Post CABG with non diagnostic ST elevation

•Quantitative serial Troponin testing in all STEMI patients to estimate infarct size and prognosis

•Troponin T or I levels are the most specific and sensitive tests

•Collect blood sample at presentation

•Often the biomarkers need to be repeated when the diagnosis of STEMI is uncertain

•Negative Troponin assay at 12 h after symptom onset practically excludes STEMI

•Know the limits and cut offs of the assay used in your hospital

•hs Troponin assay enables very early diagnosis

•A repeat hs Troponin assay may be ordered within 2–3 h

•A rise or fall in serial Troponin assay is more specific for an evolving ischemic injury

•CK-MB testing may be done when Troponin is not available or in late presenters to estimate infarct size