Exclusion of Acute Myocardial Infarction. The Value of Measuring Creatine Kinase Slope

Bakker, A.; Koelemay, M.J.W.; Vlies, B. Van; Gorgels, J. P. M. C.; Smits, R.; Tijssen, Jan G.P.; Haagen, F. D. M.

doi:10.1515/cclm.1995.33.6.351

Cited by 5 publications

(4 citation statements)

References 41 publications

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“…Ideally one test would both rule out and rule in myocardial infarction. No single test is currently sensitive and specific enough to rule out myocardial infarction in the first 6-8 hours after onset of chest pain,11 and electrocardiography, although highly specific (77-100%), has too low a sensitivity (56%) to be used in this way. 12 13…”

Section: Introductionmentioning

confidence: 99%

Is it possible to exclude a diagnosis of myocardial damage within six hours of admission to an emergency department? Diagnostic cohort

Herren

Mackway‐Jones²,

Richards³

et al. 2001

BMJ

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Objective To assess the clinical efficacy and accuracy of an emergency department based six hour rule-out protocol for myocardial damage. Design Diagnostic cohort study. Setting Emergency department of an inner city university hospital. Participants 383 consecutive patients aged over 25 years with chest pain of less than 12 hours' duration who were at low to moderate risk of acute myocardial infarction. Intervention Serial measurements of creatine kinase MB mass and continuous ST segment monitoring for six hours with 12 leads. Main outcome measure Performance of the diagnostic test against a gold standard consisting of either a 48 hour measurement of troponin T concentration or screening for myocardial infarction according to the World Health Organization's criteria. Results Outcome of the gold standard test was available for 292 patients. On the diagnostic test for the protocol, 53 patients had positive results and 239 patients had negative results. There were 18 false positive results and one false negative result. Sensitivity was 97.2% (95% confidence interval 95.0% to 99.0%), specificity 93.0% (90.0% to 96.0%), the negative predictive value 99.6%, and the positive predictive value 66.0%. The positive likelihood ratio was 13.9 and the negative likelihood ratio 0.03. Conclusions The six hour rule-out protocol for myocardial infarction is accurate and efficacious. It can be used in patients presenting to emergency departments with chest pain indicating a low to moderate risk of myocardial infarction.

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Section: Introductionmentioning

confidence: 99%

Is it possible to exclude a diagnosis of myocardial damage within six hours of admission to an emergency department? Diagnostic cohort

Herren

Mackway‐Jones²,

Richards³

et al. 2001

BMJ

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“…The patients in the gradually decreasing group had excellent baseline renal function, revealing a very low proportion of CKD. Under normal circumstances, myoglobin is excreted through kidneys, and it returns to the normal range within 20-30 h in patients with acute myocardial infarction (31). Renal dysfunction injury leads to the excretion disorder of myoglobin, resulting in the increased level of myoglobin.…”

Section: Discussionmentioning

confidence: 99%

Dynamic increase in myoglobin level is associated with poor prognosis in critically ill patients: a retrospective cohort study

Liu,

Jiang,

Yuan

et al. 2024

Front. Med.

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BackgroundMyoglobin is an important biomarker for monitoring critically ill patients. However, the relationship between its dynamic changes and prognosis remains unclear.MethodsWe retrospectively enrolled 11,218 critically ill patients from a general and surgical intensive care unit (ICU) of a tertiary hospital between June 2016 and May 2020. Patients with acute cardiovascular events, cardiac and major vascular surgeries, and rhabdomyolysis were excluded. To investigate the early myoglobin distribution, the critically ill patients were stratified according to the highest myoglobin level within 48 h after ICU admission. Based on this, the critically ill patients with more than three measurements within 1 week after ICU admission were included, and latent class trajectory modeling was used to classify the patients. The characteristics and outcomes were compared among groups. Sensitivity analysis was performed to exclude patients who had died within 72 h after ICU admission. Restricted mean survival time regression model based on pseudo values was used to determine the 28-day relative changes in survival time among latent classes. The primary outcome was evaluated with comparison of in-hospital mortality among each Trajectory group, and the secondary outcome was 28-day mortality.ResultsOf 6,872 critically ill patients, 3,886 (56.5%) had an elevated myoglobin level (≥150 ng/mL) at admission to ICU, and the in-hospital mortality significantly increased when myoglobin level exceeded 1,000 μg/mL. In LCTM, 2,448 patients were unsupervisedly divided into four groups, including the steady group (n = 1,606, 65.6%), the gradually decreasing group (n = 523, 21.4%), the slowly rising group (n = 272, 11.1%), and the rapidly rising group (n = 47, 1.9%). The rapidly rising group had the largest proportion of sepsis (59.6%), the highest median Sequential Organ Failure Assessment (SOFA) score (10), and the highest in-hospital mortality (74.5%). Sensitivity analysis confirmed that 98.2% of the patients were classified into the same group as in the original model. Compared with the steady group, the rapidly rising group and the slowly rising group were significantly related to the reduction in 28-day survival time (β = −12.08; 95% CI −15.30 to −8.86; β = −4.25, 95% CI −5.54 to −2.97, respectively).ConclusionElevated myoglobin level is common in critically ill patients admitted to the ICU. Dynamic monitoring of myoglobin levels offers benefit for the prognosis assessment of critically ill patients.

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“…A CK-MB fraction 19 ! 5% and/or a >2-fold increase of total CK activity 19 above the upper limit of normal was considered diagnostic for acute MI. For patients with UA, troponin T (tnT) serum levels were also estimated.…”

Section: Laboratory Parametersmentioning

confidence: 99%

Levels of sCD40 Ligand in Chronic and Acute Coronary Syndromes and its Relation to Angiographic Extent of Coronary Arterial Narrowing

et al. 2010

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We determined the serum levels of soluble CD40 ligand (sCD40L) in patients with chronic coronary artery disease (CAD) and acute coronary syndrome (ACS). Patients with unstable angina (UA) and myocardial infarction (MI) showed significantly higher levels (P < .001) of sCD40L compared with patients with stable angina (SA) and controls; particularly, high levels occurred in patients with UA (UA: 9.23 +/- 2.92, MI: 7.38 +/- 1.05, SA: 4.42 +/- 1.08; control: 4.01 +/- 0.87 ng/mL). There was no significant difference in sCD40L levels between patients with UA and MI or between patients with SA and controls. Levels of sCD40L did not show any significant correlation with peak creatine kinase (CK), CK-MB isoenzyme activity in patients with MI, troponin T serum levels in patients with UA or with culprit vessel (CV) complexity score (CVCS), type of CV lesion, or vessel score in patients with UA or MI. These results suggest that CD40L plays a pathogenic role in triggering ACS.

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Exclusion of Acute Myocardial Infarction. The Value of Measuring Creatine Kinase Slope

Cited by 5 publications

References 41 publications

Is it possible to exclude a diagnosis of myocardial damage within six hours of admission to an emergency department? Diagnostic cohort

Is it possible to exclude a diagnosis of myocardial damage within six hours of admission to an emergency department? Diagnostic cohort

Dynamic increase in myoglobin level is associated with poor prognosis in critically ill patients: a retrospective cohort study

Levels of sCD40 Ligand in Chronic and Acute Coronary Syndromes and its Relation to Angiographic Extent of Coronary Arterial Narrowing

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