Acute Coronary Syndrome
Virtual Grand Rounds

Ask the Experts Q & A

In the modern era of reperfusion therapy, can we still rely on peak creatine kinase (CK) (or peak troponin) to quantify the amount of myocardial necrosis?

Within the context of reperfusion, the area under the CK curve is the better measure (MRI is probably the best measure).  The peak CK is not as good but is often used. Correlations with troponin have not been well validated.

Once there was no availability for PCI in the hospital where the patient was taken, why wasn’t thrombolysis done at once?

Thrombolysis should be undertaken as soon as possible, if timely PCI is not possible (regardless of an onsite PCI service).  However, many hospitals do not have the confidence or capacity to provide thrombolysis in a timely manner, particularly small, rural hospitals.  However, you are right—one should lyse the thrombus if the time to PCI is >60 minutes.