For patients with acute coronary syndrome, is initial measurement of troponin alone the best we have to offer?

On the other hand, with the emergence of new markers, basically troponins and CKMB mass (“biomarkers of myocardial necrosis”), new evidence began to emerge. For example, many patients who were categorized as having unstable angina have received a diagnosis of acute myocardial infarction without ST segment elevation, because these biomarkers are more sensitive than the enzymes previously used. On the other hand, it was also found that approximately 30% of patients with increased troponin levels have normal CKMB activity, and that these patients have a worse prognosis than those with normal troponin. This relevant study by Santos et al1 contributes to a better understanding of the topic, to analyze the role of troponin and CKMB mass in an unselected population of patients with clinical symptoms compatible with acute coronary syndrome (somewhat with surprisingly 2/3 of patients with unstable angina, and only 1/3 with AMI without ST elevation).