Frequency of Concordant and Discordant Creatine Kinase-MB and Troponin Measurements in Acute Coronary Syndromes and Its Impact on In-hospital Mortality

Objective: The objective of this study was to determine the frequency of concordant and discordant creatine kinase-MB and troponin measurements in acute coronary syndromes its impact on in-hospital mortality. Materials and Methods: This Descriptive cross-sectional study was conducted at Emergency Department and Coronary Care Units of DHQ teaching hospital Sargodha from June 2012 t0 December 2012. 250 Patients fulfilling the inclusion and exclusion criteria were included for the study after an informed consent. Blood samples were sent to laboratory for estimation creatine kinase-MB and troponin levels. Study population was divided into two Groups. Group I consisting of patients with discordant cardiac enzymes and Group II consisting of patients with concordant cardiac enzymes. Routine protocol was offered to each patient and all patients were followed for mortality for three days. Results: Out of 250 patients 54(21.6%) had discordant and 196(78.4%) had concordant cardiac enzymes. Over all in hospital mortality was 20(8%).In-hospital mortality was 15(7.58%) in Troponin +ve patients and 10(5.41%) in CKMB +ve patients. With a significant difference (p-value 0.05). Conclusion: Among patients with NSTEMI, the possibility of discordance between CK-MB and Troponin results has become increasingly recognized. An elevated troponin level identifies patients at increased acute risk regardless of CK-MB status, but an isolated CK-MB_ status has limited prognostic value. Recognition of these risk differences may contribute to more appropriate early use of antithrombotic therapy and invasive management for all increase troponin levels patients.