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Early CK‐MB Elevations Predict Ischemic Events in Stable Chest Pain Patients
Author(s) -
Hedges Jerris R.,
Young Gary P.,
Henkel Gary F.,
Gibler W. Brian,
Green Terrence R.,
Swanson J. Robert
Publication year - 1994
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.1994.tb02794.x
Subject(s) - medicine , chest pain , cardiology , emergency medicine
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 ≥0.1 mV in ≥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 ratio 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 of otherwise low‐risk patients who develop ischemic events; other markers for diagnosing myocardial ischemia in the ED are needed.