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Delta CK-MB outperforms delta troponin I at 2 hours during the ED rule out of acute myocardial infarction.
Am J Emerg Med. 2000 Jan; 18(1):1-8.AJ

Abstract

It has been shown that a rise in creatine kinase MB bank (CK-MB) of > or = + 1.6 ng/mL in 2 hours is more sensitive and equally specific for detection of acute myocardial infarction (AMI) as compared with a 2-hour CK-MB > or = 6 ng/mL during the emergency department (ED) evaluation of chest pain. Because cardiac specific troponin I (cTnI) is thought to have similar early release kinetics as compared with CK-MB mass, we undertook a retrospective cohort study in 578 chest pain patients whose baseline CK-MB and cTnI was less than two times the hospital's upper limits of normal and who underwent a 2-hour CK-MB and cTnI to compare sensitivities and specificities of the 2-hour delta CK-MB (deltaCK-MB) and delta cTnI (delta cTnI) for AMI and 30-day Adverse Outcome (AO). Thirty day AO was defined as AMI, life-threatening complication, death, or percutaneous transluminal coronary angioplasty (PTCA)/coronary artery bypass graft (CABG) within 30 days of ED presentation. Optimum delta values were determined by choosing the smallest cutoff value greater than the assay precision where the deltaCK-MB and delta cTnI had a positive likelihood ratio for 30-day AO of > or = 15. A deltaCK-MB > or = +1.5 ng/mL was more sensitive than a deltaTnI > or = +0.2 ng/mL for AMI (87.7% versus 61.4%; P < .0005) and 30-day AO (56.7% versus 42.3%; P < .005). There were no differences in specificities for AMI and 30-day AO. Combining the two tests (MBdelta > or = +1.5 ng/mL and/or a deltaTnI > or = +0.2 ng/mL) resulted in an incremental increase in sensitivity of 89.5% for AMI and 61.9% for AO (P < .005). Patients with either a rise in CK-MB of > or = +1.5 ng/mL or rise in cTnI of > or = +0.2 ng/mL in 2 hours should receive consideration for aggressive antiischemic therapy and further diagnostic testing before making an exclusionary diagnosis of nonischemic chest pain.

Authors+Show Affiliations

Department of Emergency Medicine, Erlanger Medical Center, University of Tennessee College of Medicine, Chattanooga 37405, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

10674522

Citation

Fesmire, F M.. "Delta CK-MB Outperforms Delta Troponin I at 2 Hours During the ED Rule Out of Acute Myocardial Infarction." The American Journal of Emergency Medicine, vol. 18, no. 1, 2000, pp. 1-8.
Fesmire FM. Delta CK-MB outperforms delta troponin I at 2 hours during the ED rule out of acute myocardial infarction. Am J Emerg Med. 2000;18(1):1-8.
Fesmire, F. M. (2000). Delta CK-MB outperforms delta troponin I at 2 hours during the ED rule out of acute myocardial infarction. The American Journal of Emergency Medicine, 18(1), 1-8.
Fesmire FM. Delta CK-MB Outperforms Delta Troponin I at 2 Hours During the ED Rule Out of Acute Myocardial Infarction. Am J Emerg Med. 2000;18(1):1-8. PubMed PMID: 10674522.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Delta CK-MB outperforms delta troponin I at 2 hours during the ED rule out of acute myocardial infarction. A1 - Fesmire,F M, PY - 2000/2/16/pubmed PY - 2000/2/26/medline PY - 2000/2/16/entrez SP - 1 EP - 8 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 18 IS - 1 N2 - It has been shown that a rise in creatine kinase MB bank (CK-MB) of > or = + 1.6 ng/mL in 2 hours is more sensitive and equally specific for detection of acute myocardial infarction (AMI) as compared with a 2-hour CK-MB > or = 6 ng/mL during the emergency department (ED) evaluation of chest pain. Because cardiac specific troponin I (cTnI) is thought to have similar early release kinetics as compared with CK-MB mass, we undertook a retrospective cohort study in 578 chest pain patients whose baseline CK-MB and cTnI was less than two times the hospital's upper limits of normal and who underwent a 2-hour CK-MB and cTnI to compare sensitivities and specificities of the 2-hour delta CK-MB (deltaCK-MB) and delta cTnI (delta cTnI) for AMI and 30-day Adverse Outcome (AO). Thirty day AO was defined as AMI, life-threatening complication, death, or percutaneous transluminal coronary angioplasty (PTCA)/coronary artery bypass graft (CABG) within 30 days of ED presentation. Optimum delta values were determined by choosing the smallest cutoff value greater than the assay precision where the deltaCK-MB and delta cTnI had a positive likelihood ratio for 30-day AO of > or = 15. A deltaCK-MB > or = +1.5 ng/mL was more sensitive than a deltaTnI > or = +0.2 ng/mL for AMI (87.7% versus 61.4%; P < .0005) and 30-day AO (56.7% versus 42.3%; P < .005). There were no differences in specificities for AMI and 30-day AO. Combining the two tests (MBdelta > or = +1.5 ng/mL and/or a deltaTnI > or = +0.2 ng/mL) resulted in an incremental increase in sensitivity of 89.5% for AMI and 61.9% for AO (P < .005). Patients with either a rise in CK-MB of > or = +1.5 ng/mL or rise in cTnI of > or = +0.2 ng/mL in 2 hours should receive consideration for aggressive antiischemic therapy and further diagnostic testing before making an exclusionary diagnosis of nonischemic chest pain. SN - 0735-6757 UR - https://www.unboundmedicine.com/medline/citation/10674522/Delta_CK_MB_outperforms_delta_troponin_I_at_2_hours_during_the_ED_rule_out_of_acute_myocardial_infarction_ DB - PRIME DP - Unbound Medicine ER -