Elevated CK-MB levels within three hours of ED presentation in stable chest pain patients were associated with an increased risk of an ischemic event within 48 hours (RR 9.5; 95% CI 2.7-33.7).
Cohort (n=449)
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Does an elevated CK-MB level within three hours of ED presentation predict subsequent ischemic events in clinically stable chest pain patients?
Early CK-MB elevation in stable chest pain patients without ST-elevation strongly predicts short-term ischemic events, though it lacks sensitivity to identify all at-risk patients.
Relative Risk: 9.5 (95% CI 2.7–33.7)
OBJECTIVE: To demonstrate that creatine kinase-MB fraction (CK-MB) elevations within three hours of presentation in the emergency department (ED) are associated with subsequent ischemic events in clinically stable chest pain patients. METHODS: Prospective cohort study at two university- affiliated teaching hospitals. Participants were consenting ED chest pain patients 25 years old or older without evidence of rhythm or hemodynamic instability (n = 449). Exclusions included ST-segment elevation > or = 0.1 mV in > or = 2 electrocardiogram leads, chest wall trauma, abnormal x-ray studies, and incomplete data collection. Measurements included presenting and three-hour CK-MB levels, presenting ECG, initial clinical impression of coronary care unit need, and clinical follow up. Monitored adverse events included myocardial ischemia necessitating coronary angioplasty or cardiac bypass surgery, recurrent in-hospital myocardial infarction, bradycardia requiring pacing, emergent cardioversion, cardiogenic shock, ventricular fibrillation, and death. RESULTS: Overall, nine (2%) of 449 patients experienced an ischemic event within the first 48 hours. All nine patients required either coronary angioplasty or bypass surgery. Four (44%) of the nine patients with 48-hour ischemic events had elevated CK-MB levels. Of 23 patients who had complications within one week of ED presentation, seven (30%) had elevated ED CK-MB levels. An elevated CK-MB level was associated with an ischemic event both within 48 hours (risk ratio 9.5; 95% CI 2.7-33.7) and within one week (risk ration 5.2; 95% CI 2.3-11.7). CONCLUSIONS: An elevated CK-MB level within three hours of ED presentation is associated with a subsequent ischemic event in the clinically stable chest pain patient without ST-segment elevation. However, the ED CK-MB identifies only a minority or otherwise low-risk patients who develop ischemic events; other markers for diagnosing myocardial ischemia in the ED are needed.
Hedges et al. (Sat,) conducted a cohort in clinically stable chest pain (n=449). Elevated CK-MB levels within three hours of ED presentation vs. Normal CK-MB levels was evaluated on Ischemic event within 48 hours (RR 9.5, 95% CI 2.7-33.7). Elevated CK-MB levels within three hours of ED presentation in stable chest pain patients were associated with an increased risk of an ischemic event within 48 hours (RR 9.5; 95% CI 2.7-33.7).
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