Evaluation of Creatine Kinase and Creatine Kinase—MB for Diagnosing Myocardial Infarction

Lee, Thomas H.

doi:10.1001/archinte.1987.00370010113026

Cited by 92 publications

(9 citation statements)

References 37 publications

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“…The study center, consistent with many centers regionally and abroad, uses unfractionated CK rather than CK-MB to screen for AMI in the ED population. This is because, although the specificity for cardiac injury of CK-MB is higher than CK, the sensitivity of CK has been shown to be slightly higher than that of CK-MB [10]. Previous studies in the era of hsTnT have studied only CK-MB or CK-MB index [2, 4, 5], and this study therefore adds to the literature by showing that even screening with unfractionated CK is of no added value in diagnosis of ACS.…”

Section: Discussionmentioning

confidence: 99%

Routine creatine kinase testing does not provide clinical utility in the emergency department for diagnosis of acute coronary syndromes

Wiens¹,

Arbour²,

Thompson³

et al. 2019

BMC Emerg Med

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Background Despite the high sensitivity and negative predictive value of contemporary high-sensitivity troponin T assays (hsTnT), creatine kinase (CK) continues to be routinely tested for the diagnosis of acute coronary syndrome (ACS). We conducted a study to identify the clinical utility of routine CK measurement, its relevance in clinical decision making in the era of hsTnT, and the potential cost-savings achievable by limiting its use. Methods We conducted a retrospective review of all adult patients presenting to a tertiary care center in the year 2017. We identified patients presenting with cardiac complaints who had non-diagnostic hsTnT and positive CK. These patients underwent chart review to determine whether a diagnosis of AMI was made. Results A total of 36,251 presentations were reviewed. 9951 had cardiac complaints and 8150 had CK measured. 82% of these patients had hsTnT and CK measured; 2012 of these patients had non-diagnostic hsTnT with positive CK. Of these 2012 patients, only 1 was subsequently diagnosed with AMI (0.012%). CK provided no diagnostic benefit over hsTnT alone in > 99.9% of cases. With a cost for CK of $4/test, we estimated that routine CK testing costs at least $32,000 per year in our center, and over $100,000 per year across the region. Conclusion Routine CK testing does not provide a significant benefit to patient care and therefore represents an unnecessary system cost. Routine CK testing for the diagnosis of AMI should be eliminated from emergency departments in the era of hsTnT assays.

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Section: Discussionmentioning

confidence: 99%

Routine creatine kinase testing does not provide clinical utility in the emergency department for diagnosis of acute coronary syndromes

Wiens¹,

Arbour²,

Thompson³

et al. 2019

BMC Emerg Med

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“…the frequency of false-positives obtained by a creatine kinase based strategy can be reduced by including a more cardiospecific and sensitive marker like creatine kinase-MB mass concentration or troponin T. 4. applying the strategy with the creatine slope procedure for exclusion of myocardial infarction, and a more cardiospecific marker for confirmation (troponin T or creatine kinase-MB mass concentration) reduces laboratory costs, but does not fully account for detecting minor myocardial cell damage in patients not yet fulfilling the criteria of the World Health Organization for diagnosis of acute myocardial infarction.…”

Section: Resultsmentioning

confidence: 99%

Exclusion of Acute Myocardial Infarction. The Value of Measuring Creatine Kinase Slope

Bakker¹,

Koelemay²,

Vlies³

et al. 1995

CCLM

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For the exclusion (and diagnosis) of acute myocardial infarction, we studied timed sequential (slope) measurements of creatine kinase and creatine kinase-MB catalytic activity concentration, creatine kinase-MB mass concentration, troponin T and myoglobin, using data from 242 patients consecutively admitted for evaluation of suspected acute myocardial infarction in the 12 hours before admission. Three biochemical strategies based on measurements in two consecutive samples obtained within 12 hours after admission were evaluated. The highest sensitivities were encountered for a biochemical strategy based on the sole measurement of creatine kinase mass concentration (98%) or troponin T (96%) and a strategy based on measurements of creatine kinase activity concentrations, which includes creatine kinase slope calculation and measurement of creatine kinase mass concentration (95%). Both strategies were applied in subgroups of patients based on the electrocardiographic findings. In patients with a normal electrocardiogram, the sensitivity of the strategy using sole measurements of creatine kinase mass concentration was 100%, but this was also true for the strategy based on creatine kinase slope measurements, which is the cheaper and therefore preferred procedure for excluding myocardial infarction. This approach, however, does not account for detecting minor myocardial cell damage in patients not yet fulfilling the criteria of the World Health Organization for diagnosing acute myocardial infarction.

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“…The delayed release kinetics of myosin can explain this fact. Although myoglobin and CK-MB are sensitive markers of use in ruling out cardiac injury regardless of its origin (Luna et al 1982(Luna et al , 1983Cairns et al 1983;Grenadier et al 1983;Stone and Willerson 1983;Stewart et al 1984;Lee and Goldman 1986;Hoberg et al 1987;Lee et al 1987;Isakov et al 1988), myosin is an excellent marker of severe myocardial injury. Higher concentrations of myosin are often accompanied by observable morphological signs of heart damage, and are thus useful in diagnosing sudden death due to heart-related causes.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of myosin in the postmortem diagnosis of myocardial damage

et al. 1995

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In some situations the postmortem diagnosis of myocardial infarction is made difficult by the brief course of the fatal episode or by interferences caused by autolysis. In such cases, biochemical indices may provide a useful adjunct to morphological studies. Myosin is the main component of the contractile apparatus of muscle cells, so its determination may well be useful to evaluate myocardial injury. The purpose of the present study was to establish the diagnostic efficacy of postmortem myosin heavy chain determinations using monoclonal antibodies and to compare this data with structural findings used to diagnose acute myocardial ischaemia. We studied 105 cadavers with a mean age of 61.63 +/- 2.21 years. Cases were allocated to 1 of 7 diagnostic groups depending on the probable intensity of myocardial damage and cause of death. The highest serum and pericardial fluid values of myosin heavy chains were seen in subjects who showed morphological evidence of myocardial ischaemia. Mean pericardial fluid/serum ratios differed significantly between subjects with and without observable signs of heart damage.

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Evaluation of Creatine Kinase and Creatine Kinase—MB for Diagnosing Myocardial Infarction

Cited by 92 publications

References 37 publications

Routine creatine kinase testing does not provide clinical utility in the emergency department for diagnosis of acute coronary syndromes

Routine creatine kinase testing does not provide clinical utility in the emergency department for diagnosis of acute coronary syndromes

Exclusion of Acute Myocardial Infarction. The Value of Measuring Creatine Kinase Slope

Usefulness of myosin in the postmortem diagnosis of myocardial damage

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