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To the Editor.—Dr Mahalingam and Ottlinger¹ report the case of an elderly patient with angina pectoris on exertion associated with discrepancies in laboratory values comprising an increase in quantitative cardiac troponin T (cTnT) and in total and MB creatine kinase (CK) and a negative result for cTnT rapid test. They conclude that the cTnT rapid test failed to diagnose myocardial infarction in this patient. However, we propose another hypothesis: that the patient had no myocardial infarction but only a macro CK in his serum.

Macro CK is an abnormal CK isoenzyme found in approximately 1% of patients tested for CK.² Type 1 macro CK may result from aggregates of monoclonal IgG and is reported to be associated with autoimmune diseases. Type 2 macro CK may be associated with neoplastic diseases. Macro CK may be responsible for an increased plasma concentration of total and MB CK when these parameters are . . . [Full Text of this Article]

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RELATED LETTER

False-Negative Qualitative Cardiac Troponin T in a 79-Year-Old Man With Myocardial Infarction
Meera Mahalingam and Michael E. Ottlinger
JAMA. 1997;278(24):2143-2144.
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