Delta creatine kinase-MB outperforms myoglobin at two hours during the emergency department identification and exclusion of troponin positive non-ST-segment elevation acute coronary syndromes

Annals of Emergency Medicine
F M FesmireTheodore A Feintuch

Abstract

Limited information is available about the diagnostic performance of creatine kinase (CK)-MB and myoglobin levels during the early evaluation of chest pain patients using cardiac troponins as the criterion standard for diagnosing acute myocardial infarction. In this study, we compare the sensitivity and specificity of the baseline, 2-hour absolute, and 2-hour delta values of myoglobin and CK-MB mass assay for detection of acute myocardial infarction using cardiac troponin I (troponin) as the sole marker of myocardial necrosis. A prospective observational study was conducted of 975 chest pain patients with a baseline troponin level of 1.0 ng/mL or less (Abbott Axsym Assay) and an initial ECG nondiagnostic for injury. CK-MB, myoglobin, and troponin levels were all measured on the Abbott Axsym immunoassay. Acute myocardial infarction was diagnosed if there was at least 20 minutes of chest pain and any one of the following criteria within 24 hours of ED presentation: a serial increase in troponin to more than 1.0 ng/mL, new Q-wave formation in 2 contiguous leads, or patient death by cardiac or unknown cause. The optimal values of CK-MB and myoglobin were chosen at the most accurate value on the receiver operating characteristic (RO...Continue Reading

Citations

May 17, 2011·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Adam H MillerMicheal T Kashner
Apr 13, 2006·Scandinavian Cardiovascular Journal : SCJ·Kristian BartnesTruls Myrmel
Dec 25, 2009·The New England Journal of Medicine·Axel Bauer, Meinrad Gawaz
Dec 15, 2010·Current Treatment Options in Cardiovascular Medicine·Maame Yaa A B Yiadom, Joshua M Kosowsky
Aug 29, 2006·Annals of Emergency Medicine·Francis M FesmireUNKNOWN American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Non-ST-Segment Elevation Acut
Dec 23, 2009·Clinical Biochemistry·Peter A KavsakAllan S Jaffe

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