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Figure 5 Timing of Release of Various Biomarkers After Acute Myocardial Infarction

The biomarkers are plotted showing the multiples of the cutoff for acute myocardial infarction (AMI) over time. The dashed horizontal line shows the upper limit of normal (ULN; defined as the 99th percentile from a normal reference population without myocardial necrosis; the coefficient of variation of the assay should be 10% or less) The earliest rising biomarkers are myoglobin and CK isoforms (leftmost curve). CKMB (dashed curve) rises to a peak of 2 to 5 times the ULN and typically returns to the normal range within 2 to 3 d after AMI. The cardiac-specific troponins show small elevations above the ULN in small infarctions (e.g., as is often the case with NSTEMI) but rise to 20 to 50 times the ULN in the setting of large infarctions (e.g., as is typically the case in STEMI). The troponin levels may stay elevated above the ULN for 7 d or more after AMI. Modified from Shapiro BP, Jaffe AS. Cardiac biomarkers. In: Murphy JG, Lloyd MA, editors. Mayo Clinic Cardiology: Concise Textbook. 3rd ed. Rochester, MN: Mayo Clinic Scientific Press and New York: Informa Healthcare USA, 2007: 773–80 (70). Used with permission of Mayo Foundation for Medical Education and Research. CK = creatine kinase; CKMB = MB fraction of creatine kinase; CV = coefficient of variation; MI = myocardial infarction; NSTEMI = non–ST-elevation myocardial infarction; UA/NSTEMI = unstable angina/non–ST-elevation myocardial infarction.