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. 1989 Nov;42(11):1126–1131. doi: 10.1136/jcp.42.11.1126

Diagnosis of acute myocardial infarction from sequential enzyme measurements obtained within 12 hours of admission to hospital.

P O Collinson 1, E M Ramhamadany 1, S B Rosalki 1, J Joffe 1, D H Evans 1, R S Fink 1, T W Greenwood 1, I M Baird 1
PMCID: PMC501966  PMID: 2584422

Abstract

A prospective study was made of sequential changes in serum creatine kinase (CK) and CK-MB isoenzyme activity within the 12 hours following admission to the coronary care unit on 65 patients with recent chest pain. CK determinations were performed in the laboratory or in the coronary care unit using a dry reagent strip analyser. Slope values for log CK/hour and log CK-MB/hour were calculated, used to confirm or exclude the diagnosis of myocardial infarction, and compared with diagnosis by conventional means. Compared with retrospective diagnosis using all available information, the CK slope had a sensitivity of 100% and a specificity of 94%. This compared with a sensitivity of 94% and specificity of 90% for diagnosis using upper reference limits alone. Determination of CK slope permits very rapid and accurate biochemical confirmation or exclusion of myocardial infarction and the possibility of performing the measurements on the coronary care unit. It additionally offers the prospect of major cost savings resulting from early discharge or transfer from the coronary care unit.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bernstein L. H., Reynoso G. Creatine kinase B-subunit activity in serum in cases of suspected myocardial infarction: a prediction model based on the slope of MB increase and percentage CK-MB activity. Clin Chem. 1983 Mar;29(3):590–592. [PubMed] [Google Scholar]
  2. Bernstein L. H., Sachs E., Jonas A. Timed sequential measurements of creatine kinase MB in diagnosis of myocardial infarction. Clin Chem. 1984 Sep;30(9):1588–1589. [PubMed] [Google Scholar]
  3. Bernstein L. H., Scinto P. Two methods compared for measuring LD-1/total LD activity in serum. Clin Chem. 1986 May;32(5):792–796. [PubMed] [Google Scholar]
  4. Chapelle J. P., Heusghem C. Semi-quantitative estimation of serum myoglobin by a rapid latex agglutination method: an emergency screening test for acute myocardial infarction. Clin Chim Acta. 1985 Jan 30;145(2):143–150. doi: 10.1016/0009-8981(85)90281-5. [DOI] [PubMed] [Google Scholar]
  5. Collinson P. O., Rosalki S. B., Flather M., Wolman R., Evans T. Early diagnosis of myocardial infarction by timed sequential enzyme measurements. Ann Clin Biochem. 1988 Jul;25(Pt 4):376–382. doi: 10.1177/000456328802500409. [DOI] [PubMed] [Google Scholar]
  6. Gerhardt W., Waldenström J., Hörder M., Hofvendahl S., Billström R., Ljungdahl R., Berning H., Bagger P. Creatine kinase and creatine kinase B-subunit activity in serum in cases of suspected myocardial infarction. Clin Chem. 1982 Feb;28(2):277–283. [PubMed] [Google Scholar]
  7. Goldman L., Cook E. F., Brand D. A., Lee T. H., Rouan G. W., Weisberg M. C., Acampora D., Stasiulewicz C., Walshon J., Terranova G. A computer protocol to predict myocardial infarction in emergency department patients with chest pain. N Engl J Med. 1988 Mar 31;318(13):797–803. doi: 10.1056/NEJM198803313181301. [DOI] [PubMed] [Google Scholar]
  8. Jaffe A. S., Serota H., Grace A., Sobel B. E. Diagnostic changes in plasma creatine kinase isoforms early after the onset of acute myocardial infarction. Circulation. 1986 Jul;74(1):105–109. doi: 10.1161/01.cir.74.1.105. [DOI] [PubMed] [Google Scholar]
  9. Lee T. H., Weisberg M. C., Cook E. F., Daley K., Brand D. A., Goldman L. Evaluation of creatine kinase and creatine kinase-MB for diagnosing myocardial infarction. Clinical impact in the emergency room. Arch Intern Med. 1987 Jan;147(1):115–121. [PubMed] [Google Scholar]
  10. Mainard F., Massoubre B., Le Marec H., Madec Y. Study of a myoglobin test in patients hospitalized for suspected myocardial infarction. Clin Chim Acta. 1985 Nov 29;153(1):1–8. doi: 10.1016/0009-8981(85)90132-9. [DOI] [PubMed] [Google Scholar]
  11. McQueen M. J., Holder D., El-Maraghi N. R. Assessment of the accuracy of serial electrocardiograms in the diagnosis of myocardial infarction. Am Heart J. 1983 Feb;105(2):258–261. doi: 10.1016/0002-8703(83)90524-0. [DOI] [PubMed] [Google Scholar]
  12. Ramhamadany E. M., Collinson P. O., Evans D. H., Fink R. S., Baird I. M. Reliability of the Ames Seralyser for creatine kinase measurement in the coronary care unit. Clin Chem. 1988 Sep;34(9):1914–1914. [PubMed] [Google Scholar]
  13. Wu A. H., Gornet T. G., Wu V. H., Brockie R. E., Nishikawa A. Early diagnosis of acute myocardial infarction by rapid analysis of creatine kinase isoenzyme-3 (CK-MM) sub-types. Clin Chem. 1987 Mar;33(3):358–362. [PubMed] [Google Scholar]

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