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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.
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.
Abstract:
Thrombolysis is effective in treating patients with acute myocardial infarction when started within 12 h of onset, and thus is in widespread use. Early diagnosis is essential but some patients admitted to the coronary care unit with myocardial infarction do not meet the diagnostic criteria on arrival, and thus do not undergo thrombolysis. We studied 117 patients admitted consecutively to our coronary care unit with suspected but unproven myocardial infarction; normally none would have received thrombolytic agents. In each patient creatine kinase levels were measured on admission and after intervals by nurses using capillary blood samples and a dry chemistry system. Infarction was subsequently confirmed in 29 patients. Of these, 17 (59%) were correctly diagnosed and underwent thrombolysis within 12 h on the basis of a raised creatine kinase measured at the bedside. Our findings suggest that use of a bedside assay by nurses allows additional patients with myocardial infarction to receive the benefit of thrombolytic therapy within the first 12 h.