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February 1, 1982Clinical Chemistry

Creatine kinase and creatine kinase B-subunit activity in serum in cases of suspected myocardial infarction.

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Why the study?

Does a sequential diagnostic strategy using total creatine kinase and creatine kinase B-subunit accurately diagnose or exclude acute myocardial infarction in suspected patients?

Population

481 patients suspected of having had an acute myocardial infarction (prevalence of infarction 0.43).

Comparison

Diagnostic strategy based on sequential… vs Independent criteria for myocardial infarction.

Design

Cohort

Follow-up

within 20 hours of symptom onset

Authors

WGW. GerhardtMultiple Sclerosis SocietyJWJ. WaldenströmUniversity of GothenburgMHMogens HørderUniversity of Southern Denmark

Discussion

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Implication

Supports sequential CK/CK-B testing for high-sensitivity AMI diagnosis in this cohort; leaves open validation against contemporary troponin assays.

Key Points

  • To evaluate a sequential diagnostic strategy utilizing clinical criteria, total creatine kinase, and creatine kinase B-subunit activity to diagnose or exclude acute myocardial infarction.
  • Evaluated 481 patients with suspected acute myocardial infarction (prevalence = 0.43) using clinical criteria and two serum samples collected 10 to 20 hours after symptom onset.
  • Applied total creatine kinase discrimination thresholds (150 U/L for women and 200 U/L for men), followed by immunoinhibition testing for creatine kinase B-subunit (threshold: 12 U/L) on samples with elevated total activity.
  • Total creatine kinase thresholds achieved a diagnostic sensitivity of 0.99 and excluded 68% of 274 non-infarct cases within 20 hours with a negative posterior probability of 0.99.
  • Creatine kinase B-subunit activity exceeding 12 U/L among 292 total-CK-positive patients confirmed myocardial infarction in 99% of 207 cases.
  • The complete sequential strategy excluded 98% of all non-infarct cases with a posterior probability of 0.99.

Structured PICO

Does a sequential diagnostic strategy using total creatine kinase and creatine kinase B-subunit accurately diagnose or exclude acute myocardial infarction in suspected patients?

P
Population
481 patients suspected of having had an acute myocardial infarction (prevalence of infarction 0.43).
I
Intervention
Diagnostic strategy based on sequential application of clinical criteria, total creatine kinase determinations in two serum samples drawn within 10 to 20 h of symptom onset, and creatine kinase B-subunit (S-CK B) determinations after immunoinhibition.
C
Comparator
Independent criteria for myocardial infarction (reference standard).
O
Outcome
Diagnostic accuracy (sensitivity and posterior probability) for acute myocardial infarction.surrogate

A sequential diagnostic strategy using total creatine kinase and creatine kinase B-subunit provides high sensitivity and posterior probability for diagnosing or excluding acute myocardial infarction.

Cite This Study

Gerhardt et al. (1982) studied this question.

synapsesocial.com/papers/6a7bd1cb6a3376405375d039https://doi.org/10.1093/clinchem/28.2.277
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Serum creatine kinase B subunit activity in diagnosis of acute myocardial infarction.1980 · 17 citations
  2. 2Evaluation of Creatine Kinase and Creatine Kinase—MB for Diagnosing Myocardial Infarction1987 · 91 citations
  3. 3Creatine kinase‐MB mass concentration versus creatine kinase‐B activity for the detection of acute myocardial infarction in patients with slightly elevated total creatine kinase activity in serum1994 · 5 citations
  4. 4Serial Measurements of Serum Creatine Kinase are of Most use in the Exclusion of Acute Myocardial Infarction in Patients with a History of Heart Disease1996 · 2 citations
  5. 5At what level of serum total creatine kinase activity can measurement of serum creatine kinase MB isoenzyme activity be omitted in suspected myocardial infarction?1989 · 5 citations