Role of Creatine Kinase in the Troponin Era: A Systematic Review
Daniel Beamish1, Tetyana Maniuk1, Muhammad Mukarram2,3
1University of Ottawa, Department of Emergency Medicine, Ottawa, Ontario, Canada.
Insights
Creatine kinase (CK) testing is not useful for diagnosing non-ST-elevated myocardial infarction (NSTEMI) when cardiac troponin (cTn) is also used. Studies show cTn is more sensitive and specific, making CK redundant for NSTEMI screening in chest pain patients.
Area of Science:
- Cardiology
- Biomarker Research
- Emergency Medicine
Background:
- Non-ST-elevated myocardial infarction (NSTEMI) diagnosis relies on clinical assessment and cardiac biomarkers.
- Cardiac troponin (cTn) assays are the most sensitive and specific biomarkers for cardiac injury.
- Many hospitals still order less specific biomarkers like creatine kinase (CK) alongside cTn for chest pain evaluation.
Purpose of the Study:
- To systematically review the utility of creatine kinase (CK) testing in the diagnostic workup of patients presenting with symptoms of NSTEMI.
- To determine if CK offers additional diagnostic value beyond cTn in NSTEMI assessment.
Main Methods:
- A systematic review was conducted searching MEDLINE, Embase, and Cochrane databases (January 1995-September 2020).
- Expert consultation was used to identify additional relevant studies.
- Eight comparative studies of CK and cTn for NSTEMI diagnosis were included after screening 2,865 papers.
Main Results:
- All eight included studies demonstrated that cTn possesses superior sensitivity and specificity compared to CK for NSTEMI diagnosis.
- No reliable evidence was found supporting the use of CK in NSTEMI diagnosis when cTn results were negative.
Conclusions:
- The use of CK in the diagnostic workup for NSTEMI in patients with undifferentiated chest pain is not supported by current evidence.
- CK should be discontinued as a screening tool for patients presenting to the emergency department with chest pain, given the established role of cTn.
Introduction:
The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. The most sensitive and specific biomarkers for cardiac injury are the troponin assays. Many hospitals continue to automatically order less sensitive and less specific biomarkers such as creatine kinase (CK) alongside cardiac troponin (cTn) for workup of patients with chest pain. The objective of this systematic review was to identify whether CK testing is useful in the workup of patients with NSTEMI symptoms.
Methods:
We undertook a systematic review to ascertain whether CK ordered as part of the workup for NSTEMI was useful in screening patients with cardiac chest pain. The MEDLINE, Embase, and Cochrane databases were searched from January 1995-September 2020. Additional papers were added after consultation with experts. We screened a total of 2,865 papers, of which eight were included in the final analysis. These papers all compared CK and cTn for NSTEMI diagnosis.
Results:
In each of the eight papers included in the analysis, cTn showed a greater sensitivity and specificity than CK in the diagnosis of NSTEMI. Furthermore, none of the articles published reliable evidence that CK is useful in NSTEMI diagnosis when troponin was negative.
Conclusion:
There is no evidence to continue to use CK as part of the workup of NSTEMI acute coronary syndrome in undifferentiated chest pain patients. We conclude that CK should not be used to screen patients presenting to the emergency department with chest pain.
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