Abstract
Background: Ruling out myocardial infarction in patients coming to the emergency room with chest pain is hindered by the lack of a specific early diagnostic marker. Less than 30 percent of patients admitted to coronary care units have infarction, resulting in substantial unnecessary expenditures. We developed a rapid assay of the subforms of creatine kinase MB (CK-MB) and prospectively analyzed its sensitivity and specificity in diagnosing myocardial infarction in the first six hours after the onset of chest pain. Methods: In 1110 consecutive patients who came to the emergency room with chest pain, blood samples were collected every 30 to 60 minutes until at least 6 hours after the onset of symptoms; in patients who were then admitted to the hospital, samples were collected every 4 hours for up to 48 hours. The samples were analyzed for CK-MB subforms, and the diagnosis of myocardial infarction was confirmed by conventional CK-MB analysis. Results: Of the 1110 patients evaluated, 121 had myocardial infarction. The sensitivity of the assay of CK-MB subforms to detect myocardial infarction in the first six hours after the onset of symptoms was 95.7 percent, as compared with only 48 percent for the conventional CK-MB assay; the specificity was 93.9 percent among patients hospitalized without myocardial infarction and 96.2 percent among those sent home. Among the patients with myocardial infarction, definitive results of the subform assay were available a mean (±SD) of 1.22 ±1.17 hours after their arrival in the emergency room. Conclusions: The assay of CK-MB subforms reliably detected myocardial infarction within the first six hours after the onset of symptoms, and its use could reduce admission to the coronary care unit by 50 to 70 percent, thereby reducing costs., Each year 5 million patients with chest pain are evaluated in hospital emergency rooms in the United States1. Less than 30 percent of the patients admitted to a coronary care unit are subsequently found to have myocardial infarction2–6. The cost of caring for these patients in whom myocardial infarction has been ruled out is approximately $4 billion per year1. Studies suggest that they could be cared for safely in a less intensive setting7,8. However, the clinical history and electrocardiogram can be nonspecific,9 and conventional assays of creatine kinase MB (CK-MB) isoenzymes may take up… © 1994, Massachusetts Medical Society. All rights reserved.