Acute myocardial infarction in chest pain patients with nondiagnostic ECGs: Serial CK-MB sampling in the emergency department

Gibler, W. Brian; Young, Gary P.; Hedges, Jerris R.; Lewis, Larry M.; Smith, Mark S.; Carleton, Steve C; Aghababian, Richard V.; Jorden, Robert O; Allison, E Jackson; Often, Edward J.; Makens, Paul K; Hamilton, C

doi:10.1016/s0196-0644(05)82515-6

Cited by 179 publications

(3 citation statements)

References 40 publications

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“…This study showed that the sensitivity of CK-MB is highly dependent on the sampling time from the onset of pain. 22 Another study by Kleiman et al compared troponin and CK-MB to predict risk in NSTEMI patients and found that out of 668 patients with positive CK-MB, 94% were troponin positive, and of 1157 patients with negative CK-MB, 32% were positive for troponin, which showed a significant correlation between troponin and CK-MB. 12 Fesmier et al performed a study on 975 patients with NSTEMI and troponin-negative (UA) that underwent two rounds of sampling of patients at the beginning of the visit (with the average onset of symptoms up to 4.5 h of sampling) and 2 h after the visit.…”

Section: Discussionmentioning

confidence: 99%

The diagnostic utility of creatine kinase-MB versus total creatine phosphokinase ratio in patients with non-ST elevation myocardial infarction from unstable angina

et al. 2023

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Objective: The present study seeks to find a way to quickly and correctly differentiate myocardial infarction from unstable angina by measuring the creatine kinase-MB/creatine phosphokinase ratio and comparing in non-ST elevation myocardial infarction patients with unstable angina at different time intervals, to improve the health quality of patients with coronary artery disease. Methods: The present study is a retrospective epidemiological analysis of 260 patients with non-ST elevation myocardial infarction and 260 patients with unstable angina, including age, sex, creatine kinase-MB, and creatine phosphokinase biomarkers at two-time intervals, including referral (4–8 h from the onset of pain) as the first interval, and 8 h after the first sampling was extracted as the second interval. Moreover, the delta of the creatine kinase-MB/creatine phosphokinase ratio during two interval times was measured. Results: In non-ST elevation myocardial infarction patients in the first and second intervals, creatine kinase-MB/creatine phosphokinase ratio was 32.7 and 33.8% higher than the normal laboratory cutoff (positive), respectively, and in the group of unstable angina patients, this index was positive in 31.9 and 30.4% of patients, respectively. There was no significant difference between the mean creatine kinase-MB to creatine phosphokinase index between the patients with non-ST elevation myocardial infarction and unstable angina ( p = 0.507). In the first interval, the sensitivity and specificity of this index in differentiating non-ST elevation myocardial infarction from unstable angina were 51.5 and 57.3% (area under the curve = 0.518), respectively. While in the second interval, the sensitivity and specificity of this index were 17.7 and 87.8% (area under the curve = 0.519), respectively. The creatine kinase-MB/creatine phosphokinase delta in the non-ST elevation myocardial infarction group was significantly higher than in patients with unstable angina during different time intervals ( p = 0.01). Conclusion: According to our results, creatine kinase-MB/creatine phosphokinase index cannot help differentiate the two groups of non-ST elevation myocardial infarction and unstable angina. However, the findings show that higher levels of creatine kinase-MB enzyme and creatine kinase-MB/creatine phosphokinase delta in the early hours, 4–16 h after the onset of pain in non-ST elevation myocardial infarction patients, can be used to differentiate between non-ST elevation myocardial infarction and unstable angina.

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Section: Discussionmentioning

confidence: 99%

The diagnostic utility of creatine kinase-MB versus total creatine phosphokinase ratio in patients with non-ST elevation myocardial infarction from unstable angina

et al. 2023

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“…The underlying diseases such as diabetes mellitus can trigger the asymptomatic MI. Some previous studies reported the different sensitivities for ECG with the highest sensitivity of 73% for MI detection (18, 19). In addition, the enzyme levels evaluation is a noninvasive, safe, and sensitive method for the detection of cardiac complications.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Cardiac Troponin I Levels in Patients Undergoing Total Hip and Total Knee Arthroplasty: A Single Center Study

et al. 2018

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BackgroundCardiac injury is one of the significant perioperative complications in major orthopedic surgeries and its early diagnosis is useful in the reduction of postoperative comorbidity. The cardiac troponin is a sensitive and specific biomarker for detecting this damage.ObjectivesThe aim of this study was to evaluate the levels of perioperative cardiac troponin I (cTnI) before and after arthroplasty in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The effects of related variables and probable major cardiac complications were evaluated in this study.MethodsFor one year, in a prospective, cross-sectional study, the serum levels of cTnI before and 48 hours after arthroplasty were evaluated in 52 patients. Possible contributing factors including age, gender, body mass index (BMI), daily activity, history of hospitalization due to cardiovascular diseases, underlying illness, and medications were recorded. The Chi-square test, Pearson correlation, and Spearman test were used to examine the relationship between variables.ResultsThe mean cTnI increased significantly after arthroplasty (P < 0.001). There was no significant relationship between age (P = 0.708), gender (P = 0.225), BMI (P = 0.195), daily activity (0.441), underlying illness (P = 0.244), and cTnI levels after arthroplasty. Linear regression showed BMI was significantly correlated with troponin changes (P = 0.006). Five patients had heart palpitations and one had chest pain, but none of the patients had any findings in favor of cardiac injury.ConclusionscTnI levels after THA and TKA increased significantly, but this elevation was in the normal range. In addition, none of them had a new cardiac complication after arthroplasty.

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“…Bearing in mind the kinetic properties of CK inside the body, the timing of checking CK in relation to the onset of chest pain is important in the interpretation of the results. In a study of 616 patients with chest pain by Gibler and his colleagues, 30 CK-MB levels were checked on presentation at Emergency departments and hourly for three hours for chest pain with non-diagnostic ECG. When the sensitivity of hourly CK-MB is represented as a function of the duration of chest pain for AMI patients with non-diagnostic ECG tracings, they found that after three hours of symptoms (i.e.…”

Section: The Ck-mbmentioning

confidence: 99%

Patient with Chest Pain of Obscure Origin: Can AMI be Recognised Early at AED? - A Review of Diagnostic Methods and a Suggested Protocol for the Local A&E Department

Man

Cheung²

2000

Hong Kong Journal of Emergency Medicine

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Chest pain is a common presentation to Accident and Emergency departments (AED). There are many causes ranging from the most trivial, an example of which is costochondritis to the life-threatening examples such as acute myocardial infarction (AMI). It is not uncommon for acute myocardial infarction to present as atypical chest pain or discomfort, or non-diagnostic electrocardiogram (ECG). The various common diagnostic methods for AMI in patients with atypical chest pain are reviewed and a suggested protocol for managing patient with chest pain of obscure origin at AED is presented. The recent introduction of rapid bedside troponin assay is likely to bring a major impact on the management of atypical chest pain in future.

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Acute myocardial infarction in chest pain patients with nondiagnostic ECGs: Serial CK-MB sampling in the emergency department

Cited by 179 publications

References 40 publications

The diagnostic utility of creatine kinase-MB versus total creatine phosphokinase ratio in patients with non-ST elevation myocardial infarction from unstable angina

The diagnostic utility of creatine kinase-MB versus total creatine phosphokinase ratio in patients with non-ST elevation myocardial infarction from unstable angina

Perioperative Cardiac Troponin I Levels in Patients Undergoing Total Hip and Total Knee Arthroplasty: A Single Center Study

Patient with Chest Pain of Obscure Origin: Can AMI be Recognised Early at AED? - A Review of Diagnostic Methods and a Suggested Protocol for the Local A&E Department

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