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Creatine kinase-MB does not add additional benefit to a negative troponin in the evaluation of chest pain.
- Source :
-
The American journal of emergency medicine [Am J Emerg Med] 2012 Jan; Vol. 30 (1), pp. 188-90. Date of Electronic Publication: 2010 Dec 03. - Publication Year :
- 2012
-
Abstract
- Objective: The aim of this study was to determine whether current troponin assay alone can be used for initial screening for acute myocardial infarction (AMI) and whether creatine kinase-MB (CK-MB) can safely be eliminated from this evaluation in the emergency department (ED).<br />Methods: A retrospective cohort study of patients who had cardiac troponin T (Roche, Basel, Switzerland) and CK-MB ordered at an urban academic level 1 trauma center with more than 55,000 annual visits. Patients with troponin testing in the ED were identified over a period of 12 months, and corresponding CK-MB indexes were examined identifying patients with negative troponins (<0.01) and positive CK-MB indexes (>6.0). In these patients, further cardiac markers, hospital course, and 30-day mortality were then evaluated. A 99% confidence interval around point estimate was used in data analysis.<br />Results: During the study period, there were 11,092 separate ED patient encounters where a patient had at least one troponin resulted. Most (97.9%) of the samples had an associated CK-MB ordered. There were 7545 initial negative troponins representing 68% of all initial samples. Seven of these had an associated positive MB index. When subsequent troponins were evaluated, an additional 4910 negative troponins were identified, with 4 patients having a positive MB. None of these 11 patients were judged to have ruled in for AMI by the treating physicians. The rate of true-positive CK-MB index with negative troponin was 0% (99% confidence interval, 0-0.04%).<br />Conclusion: Our results suggest that CK-MB is not necessary in the initial screening for AMI and may safely be omitted in patients with negative troponins.<br /> (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Biomarkers blood
Chest Pain diagnosis
Chest Pain mortality
Chi-Square Distribution
Confidence Intervals
Female
Humans
Male
Middle Aged
Myocardial Infarction diagnosis
Myocardial Infarction mortality
Predictive Value of Tests
Retrospective Studies
Trauma Centers statistics & numerical data
Chest Pain etiology
Creatine Kinase, MB Form blood
Myocardial Infarction blood
Troponin T blood
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8171
- Volume :
- 30
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The American journal of emergency medicine
- Publication Type :
- Academic Journal
- Accession number :
- 21129891
- Full Text :
- https://doi.org/10.1016/j.ajem.2010.10.016