Optimal diagnosis in acute myocardial infarction. A cost-effectiveness study

Area of Science:

• Cardiology
• Clinical Diagnostics
• Biomarker Analysis

Background:

• Accurate diagnosis of acute myocardial infarction (AMI) is critical for patient outcomes.
• Traditional diagnostic methods involve evaluating various serum enzymes and electrocardiograms (ECG).
• Predictive values (PVpos, PVneg) quantify test accuracy in diagnosing disease presence or absence.

Purpose of the Study:

• To evaluate and compare the predictive values of serum enzyme activities (CK-MB, AST, LDH, CK) and ECG for diagnosing AMI.
• To determine the most effective diagnostic marker for AMI in patients suspected of the condition.

Main Methods:

• A study involving 401 consecutively admitted patients suspected of AMI.
• Evaluation of serum enzyme activities: creatine kinase isoenzyme MB (CK-MB), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and total creatine kinase (CK).
• Assessment of electrocardiogram (ECG) findings, both individually and in combination with enzyme tests.

Main Results:

• Serum CK-MB demonstrated the highest predictive values (PVpos = 0.98, PVneg = 1.00) compared to other enzymes and ECG.
• CK-MB consistently tested positive within 17 hours of admission in all confirmed AMI cases.
• CK-MB outperformed single and serial enzyme tests, as well as ECG, in diagnostic accuracy.

Conclusions:

• Serum CK-MB is a superior diagnostic marker for acute myocardial infarction.
• Utilizing CK-MB allows for a faster and more reliable diagnosis of AMI.
• Implementing CK-MB testing can significantly reduce unnecessary hospitalization for patients without AMI.