Document Detail

Evaluation of creatine kinase and creatine kinase-MB for diagnosing myocardial infarction. Clinical impact in the emergency room.
MedLine Citation:
PMID:  3800513     Owner:  NLM     Status:  MEDLINE    
We prospectively studied the performance of emergency room strategies using a single sampling of total creatine kinase (CK) only and total CK with, if total CK levels were elevated, CK-MB levels in 639 patients with acute chest pain, including 386 patients who were admitted and 253 patients who were discharged. Acute myocardial infarction was diagnosed in 104 patients and excluded in 535. An elevated total CK level had a sensitivity of only 38% and specificity of only 80%, whereas a CK-MB level over 5% of an elevated total CK level had a sensitivity of only 34% and specificity of 88%. The sensitivities of both CK and CK-MB were higher in patients who arrived more than four hours after the onset of symptoms, and, in this population, the strategy using CK-MB performed significantly better than the strategy using total CK alone. Since a very positive CK-MB in a low-risk patient can greatly raise the probability of myocardial infarction, future strategies using CK-MB may have a role in selected subsets in determining which patients should not be sent home. However, the sensitivity of a single sampling of CK and CK-MB is too low for these assays to be used to exclude myocardial infarction in the emergency room or to be used as the rationale for deciding not to admit a patient.
T H Lee; M C Weisberg; E F Cook; K Daley; D A Brand; L Goldman
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Archives of internal medicine     Volume:  147     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  1987 Jan 
Date Detail:
Created Date:  1987-01-28     Completed Date:  1987-01-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  115-21     Citation Subset:  AIM; IM    
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MeSH Terms
Clinical Enzyme Tests*
Creatine Kinase / blood*
Emergency Service, Hospital
False Positive Reactions
Middle Aged
Myocardial Infarction / diagnosis*
Prospective Studies
Time Factors
Grant Support
Reg. No./Substance:
0/Isoenzymes; EC Kinase

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