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Diagnostic parameters of CK–MB and myoglobin related to chest pain duration

Published online by Cambridge University Press:  21 May 2015

Grant Innes ,
James Christenson ,
W. Douglas Weaver ,
Tiepu Liu ,
James Hoekstra ,
Nathan Every ,
Raymond E. Jackson ,
Paul Frederick  and
W. Brian Gibler
Grant Innes*
Affiliation:
St. Paul’s Hospital and the University of British Columbia, Vancouver, BC Royal Columbian Hospital, New Westminster, BC
James Christenson
Affiliation:
St. Paul’s Hospital and the University of British Columbia, Vancouver, BC
W. Douglas Weaver
Affiliation:
Henry Ford Heart and Vascular Institute, Detroit, Mich.
Tiepu Liu
Affiliation:
University of Cincinnati Medical Centre, Cincinnati, Ohio
James Hoekstra
Affiliation:
Ohio State University, Columbus, Ohio
Nathan Every
Affiliation:
University of Washington, Seattle, Wash.
Raymond E. Jackson
Affiliation:
Willian Beaumont Hospital, Royal Oak, Mich.
Paul Frederick
Affiliation:
University of Cincinnati Medical Centre, Cincinnati, Ohio
W. Brian Gibler
Affiliation:
University of Cincinnati Medical Centre, Cincinnati, Ohio
*
Department of Emergency Medicine, St. Paul’s Hospital, 1081 Burrard St., Vancouver BC V6Z 1Y6; 604 806-8980, fax 801 659-0455, ginnes@interchange.ubc.ca

Abstract:

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Objective:

Cardiac marker sensitivity depends on chest pain duration at the time of sampling. Our objective was to estimate the sensitivity, specificity, and likelihood ratios of early CK–MB and myoglobin assays in patients presenting to the emergency department (ED) with nondiagnostic ECGs, stratified by the duration of ongoing chest pain at the time of ED assessment.

Methods:

This was a prospective observational study carried out in 10 US and 2 Canadian EDs. Patients >25 years of age with ongoing chest pain and nondiagnostic ECGs were stratified by pain duration (0–4 h, 4–8 h, 8–12 h, >12 h). CK–MB and myoglobin assays were drawn at T = 0 (ED assessment) and T = 1 hr. Patients were followed for 7–14 days to identify all cases of acute myocardial infarction (AMI). ED test results were correlated with patient outcomes.

Results:

Of 5005 eligible patients, 565 had AMI. Pain duration was 0–4 h in 3014 patients, 4–8 h in 961, 8–12 h in 487, and >12 h in 543. Marker sensitivity increased with pain duration, ranging from 28%–77% for CK–MB and 39%–73% for myoglobin. The maximal sensitivity achieved by a T = 0 assay was 73%, and this was in patients with 8–12 or >12 h of ongoing pain. No combination of tests achieved 90% sensitivity in any pain duration strata.

Conclusions:

Regardless of chest pain duration, single assays and early serial markers (0+1 hr) do not rule out AMI; therefore, serial assays over longer observation periods are required. Likelihood ratios derived in this study will help physicians who use Bayesian analysis to determine post-test AMI likelihood in patients with chest pain.

Keywords

creatine kinasemyoglobincardiac markermyocardial infarctiontroponinCK-MBdiagnosis
Type
EM Advances • Innovations En MU
Information
Canadian Journal of Emergency Medicine , Volume 4 , Issue 5 , September 2002 , pp. 322 - 330
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

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