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Aggressive heart therapies still underused, despite blood chemical status

NEW ORLEANS -- Physicians are underutilizing aggressive therapies such as anti-clotting drugs and invasive procedures in heart patients, despite the presence of biochemical markers in the blood indicating heart muscle death, according to a new analysis by cardiologists at Duke University Medical Center.

The researchers studied patients who came to the emergency room with symptoms of a heart attack and how they were treated based on the results of two biochemicals in the blood -- creatine kinase-MB (CK-MB) and troponin. Both are proteins within cells that leak into the bloodstream as the cell wall breaks apart during cell death. The difference between the two is that troponin is only released by heart muscle, while CK-MB can be released by both dying heart and skeletal muscle.

In their analysis of a heart attack registry of almost 30,000 patients, the researchers found that 28.4 percent of the patients had differing, or discordant, marker results. Furthermore, the researchers found that when the two blood chemical results conflicted, the treatment strategy tended to be determined by the status of the CK-MB, an older and less specific test, and not by troponin, which can identify high-risk patients.

The results of the current analysis were presented today (March 10, 2004) by Duke cardiologist Kristin Newby, M.D., at the annual scientific sessions of the American College of Cardiology.

"Patients who had positive troponin levels had increased mortality regardless of the CK-MB status, but CK-MB elevation in the absence of elevated troponin did not predict increased mortality," Newby said. "Paradoxically, the early use of newer anti-platelet drugs and invasive procedures among troponin-positive patients appears biased by CK-MB status despite this risk pattern."

Newby said that recognition of these risk differences may contribute to more appropriate use of antiplatlet therapy and angioplasty.

For their analysis, the researche
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Contact: Richard Merritt
merri006@mc.duke.edu
919-684-4148
Duke University Medical Center
10-Mar-2004


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