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Emergency department CK-MB: a predictor of ischemic complications. National cooperative CK-MB project group
J W Hoekstra1, J R Hedges, W B Gibler
1Department of Emergency Medicine Ohio State University Columbus, USA.
Insights
A positive creatine kinase-MB (CK-MB) test in the emergency department (ED) significantly increases the risk of complications for chest pain patients. This finding aids in risk-stratifying patients with myocardial ischemia who have normal initial ECGs.
Area of Science:
- Cardiology
- Emergency Medicine
- Biomarker Analysis
Background:
- Chest pain evaluation in the emergency department (ED) is common.
- Identifying patients at high risk for myocardial ischemia with non-diagnostic ECGs is crucial.
- Creatine kinase-MB (CK-MB) is a cardiac biomarker used in diagnosing myocardial infarction.
Purpose of the Study:
- To determine if an elevated CK-MB level in the ED predicts an increased risk of complications in patients admitted for chest pain evaluation.
- To assess the utility of CK-MB in risk stratification for myocardial ischemia.
Main Methods:
- Prospective observational cohort study involving 5,120 patients with chest pain and no ST-segment elevation on initial ECG.
- Patients were stratified based on CK-MB levels measured on ED presentation and two hours later.
- Inpatient records were reviewed for diagnoses (myocardial infarction) and ischemic complications.
Main Results:
- 369 patients (7.2%) were diagnosed with myocardial infarction (MI).
- Patients with a positive ED CK-MB had a 16.1 times higher relative risk of any complication compared to those with negative CK-MB.
- The relative risk of death was 25.4 times higher in patients with a positive ED CK-MB.
Conclusions:
- Multicenter data confirm that CK-MB measurements are valuable for risk stratification.
- CK-MB aids in identifying patients with potential myocardial ischemia who have normal initial ECGs.
- Positive ED CK-MB levels are associated with significantly higher rates of complications and death.
Objective:
To demonstrate that a positive CK-MB in the emergency department (ED) predicts an increased risk for complications of myocardial ischemia in patients admitted to the hospital for evaluation of chest pain.
Methods:
53 academic and community hospital EDs participated in this prospective observational cohort analysis of 5,120 patients with chest pain without ST-segment elevation on the initial ED 12-lead electrocardiogram. All patients were admitted for evaluation of chest pain in one of the participating hospitals as part of the National Cooperative CK-MB Project. Patients were stratified by whether or not they had an elevated CK-MB level in the ED. CK-MB measurements were made on ED presentation and two hours later. Patient medical records were reviewed for inpatient diagnoses--myocardial infarction (MI) or other diagnosis--and for ischemic complication--cardiac-related death, recurrent or delayed in-hospital MI, significant ventricular arrhythmias, new conduction defects, congestive heart failure, and cardiogenic shock.
Results:
369 (7.2%) of the 5,120 patients had MI. The proportion of patients with any complication in the MI group was 24%, while the complication rate in the non-MI group was 0.4%. In all patients, regardless of final diagnosis, the relative risk of any complication was 16.1 (95% CI 11.0-23.6) in those with a positive ED CK-MB versus negative ED CK-MB patients. Similarly, the relative risk of death was 25.4 (95% CI 10.8-60.2) in positive ED CK-MB versus negative ED CK-MB patients.
Conclusions:
Multicenter data support the hypothesis that CK-MB measurements can help risk-stratify ED chest pain patients whose initial ECGs are without diagnostic ST-segment elevation.