Failure of Creatine Kinase Slope Values to Reliably Predict Acute Myocardial Infarction

Vijan, S.G.; Ingle, A R; Hill, Peter; Millar-Craig, M W

doi:10.1177/000456329102800119

Cited by 5 publications

(3 citation statements)

References 4 publications

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“…This procedure, however, was questioned (12,13). The cause for this debate originates from the fact that Collinson et al (9,10) evaluated a small number of patients, all having creatine kinase activity concentration at admission within the reference range, while the evaluation of Vijan et al (12) also included a number of patients with creatine kinase activity concentration above the reference range. Creatine kinase slope values have been reported to be unreliable in detecting myocardial infarction in patients with initially elevated creatine kinase activity concentration (38), which may explain the diverging results obtained with the slope procedure.…”

Section: Discussionmentioning

confidence: 99%

“…To provide Brought to you by | New York University Bobst Library Technical Services Authenticated Download Date | 6/9/15 10:03 AM rapid diagnosis and exclusion of acute myocardial infarction, the measurement of creatine kinase slope values, which reduces laboratory costs, has been proposed (9)(10)(11). The validity of this procedure however, has been questioned (12,13).…”

Section: Introductionmentioning

confidence: 99%

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

Bakker¹,

Koelemay²,

Vlies³

et al. 1995

CCLM

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For the exclusion (and diagnosis) of acute myocardial infarction, we studied timed sequential (slope) measurements of creatine kinase and creatine kinase-MB catalytic activity concentration, creatine kinase-MB mass concentration, troponin T and myoglobin, using data from 242 patients consecutively admitted for evaluation of suspected acute myocardial infarction in the 12 hours before admission. Three biochemical strategies based on measurements in two consecutive samples obtained within 12 hours after admission were evaluated. The highest sensitivities were encountered for a biochemical strategy based on the sole measurement of creatine kinase mass concentration (98%) or troponin T (96%) and a strategy based on measurements of creatine kinase activity concentrations, which includes creatine kinase slope calculation and measurement of creatine kinase mass concentration (95%). Both strategies were applied in subgroups of patients based on the electrocardiographic findings. In patients with a normal electrocardiogram, the sensitivity of the strategy using sole measurements of creatine kinase mass concentration was 100%, but this was also true for the strategy based on creatine kinase slope measurements, which is the cheaper and therefore preferred procedure for excluding myocardial infarction. This approach, however, does not account for detecting minor myocardial cell damage in patients not yet fulfilling the criteria of the World Health Organization for diagnosing acute myocardial infarction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Bakker¹,

Koelemay²,

Vlies³

et al. 1995

CCLM

View full text Add to dashboard Cite

show abstract

“…64,65 This is substantially equivalent to the principle advocated by Lee. 66 Nevertheless, a contrary evaluation of the contribution of slope measurement has been noted, 67,68 probably attributable to the author's use of electrophoresis and immunoinhibition assays. With the combination of improved sensitivity, and precision of the newer assays for biochemical markers in conjunction with computer facilitation of data handling, one anticipates that serial timed sampling can contribute a new level of diagnostic utility and sophistication.…”

Section: Clinical Chemistrymentioning

confidence: 97%

Myocardial Markers of Injury:Evolution and Insights

Keffer

1996

Am J Clin Pathol

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Timed sequential analysis of creatine kinase in the diagnosis of myocardial infarction in patients over 65 years of age.

Chattington¹,

Clarke²,

Neithercut³

1994

J Clin Pathol

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Aim-To assess the value of timed sequential analysis of creatine kinase (CK) activity for the early diagnosis of acute myocardial infarction (AMI) in patients over 65 years of age. Method-Samples were collected on admission and eight to 12 hours later from 156 patients over 65 years of age. Routine cardiac enzyme activities were determined and serial electrocardiograms (ECGs) Measurement of timed sequential creatine kinase (CK) activity in serum has been proposed as one method for early confirmation of a diagnosis of AMI.'-Like other tests for the diagnosis of AMI, this test has been evaluated in patients admitted to a coronary care unit,' 2 however, only small numbers of patients were included in these early studies. Other investigators who studied slightly larger groups of patients found that the test gave false negative results and could not be used to exclude reliably a diagnosis of AMI.78 Although a coronary care unit provides a well controlled environment in which to conduct the evaluation of a test requiring carefully timed samples, the populations studied so far have been preselected with a high incidence of AMI, up to 55%,9 and other possible confounding diagnoses may have been excluded. As a result, the test's performance may not be as accurate when evaluated in unselected elderly subjects presenting with acute chest pain. This group of subjects may also have other potential confounding diagnoses not found in younger age groups.The predictive value of a test improves with selection of the population studied and collection of samples under well controlled conditions. We therefore investigated the value of this test in patients over 65 years of age admitted to a busy district general hospital with acute chest pain.Over five months, 156 patients (88 women) presenting with acute chest pain were studied. All were over 65 years of age. The time of onset of chest pain in relation to the time of admission was recorded. Three serial electrocardiograms (ECGs) were collected, standard cardiac enzyme activities comprising total CK and lactate dehydrogenase (LDH) were determined on the three days following admission, and the results recorded. The final diagnosis at the time of discharge was also recorded.The study was approved by the District Ethics Committee and all patients gave informed consent. MethodsBlood samples for timed CK analysis were collected on admission and eight to 12 hours later. All blood samples for cardiac enzyme analysis were centrifuged, the serum separated and analysed at the time received to simulate the provision of a routine clinical service.Creatine kinase activity was measured at 37°C with a Beckman CX7 analyser (Beckman Instruments, High Wycombe, UK) using commercially available reagents (Randox, Dublin, Republic of Ireland). The between batch imprecision of this method was 4-1% at 147 IU/l and 2-3% at 467 IU/1. The laboratory upper reference range for CK was 195 IU/l for men and 170 IU/l for women.Lactate dehydrogenase activity was measured using the same instrument and reage...

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Failure of Creatine Kinase Slope Values to Reliably Predict Acute Myocardial Infarction

Cited by 5 publications

References 4 publications

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

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

Myocardial Markers of Injury:Evolution and Insights

Timed sequential analysis of creatine kinase in the diagnosis of myocardial infarction in patients over 65 years of age.

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