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Bedside measurement of creatine kinase to guide thrombolysis on the coronary care unit

A C Downie1, P G Frost, P Fielden

  • 1Central Middlesex Hospital NHS Trust, London, UK.

Lancet (London, England)
|February 20, 1993
PubMed

Insights

Bedside creatine kinase testing by nurses enabled earlier diagnosis of myocardial infarction in 59% of confirmed cases. This improved access to timely thrombolytic therapy for acute myocardial infarction patients.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Diagnostics

Background:

  • Thrombolysis is a critical treatment for acute myocardial infarction (AMI) within 12 hours of symptom onset.
  • Early diagnosis is crucial, but some AMI patients do not meet diagnostic criteria upon admission, delaying or preventing thrombolysis.
  • Current diagnostic methods may not be rapid enough for immediate treatment decisions in all suspected cases.

Purpose of the Study:

  • To evaluate the effectiveness of bedside creatine kinase (CK) assays performed by nurses for early diagnosis of myocardial infarction.
  • To determine if this method can increase the number of patients receiving timely thrombolytic therapy.

Main Methods:

  • A study of 117 patients admitted to a coronary care unit with suspected myocardial infarction.
  • Nurses measured creatine kinase levels using capillary blood samples and a dry chemistry system at the bedside.
  • Creatine kinase levels were monitored over time to assess for elevations indicative of infarction.

Main Results:

  • Myocardial infarction was confirmed in 29 out of 117 patients.
  • Of the confirmed cases, 17 patients (59%) were correctly diagnosed using the bedside CK assay.
  • These 17 patients received thrombolytic therapy within the critical 12-hour window.

Conclusions:

  • Bedside CK assays performed by nurses can facilitate earlier diagnosis of acute myocardial infarction.
  • This diagnostic approach allows more patients to benefit from time-sensitive thrombolytic therapy.
  • Implementing point-of-care testing can improve patient outcomes in acute coronary syndromes.

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