THE POTENTIAL UTILITY OF A RAPID CK-MB ASSAY IN EVALUATING EMERGENCY DEPARTMENT PATIENTS WITH POSSIBLE MYOCARDIAL-INFARCTION

被引：21

作者：

GREEN, GB ^{[1
]}

HANSEN, KN ^{[1
]}

CHAN, DW ^{[1
]}

GUERCI, AD ^{[1
]}

FLEETWOOD, DH ^{[1
]}

SIVERTSON, KT ^{[1
]}

KELEN, GD ^{[1
]}

机构：

[1] JOHNS HOPKINS UNIV,SCH MED,DIV EMERGENCY MED,BALTIMORE,MD 21205

来源：

ANNALS OF EMERGENCY MEDICINE | 1991年 / 20卷 / 09期

关键词：

CK-MB assay; myocardial infarction;

D O I：

10.1016/S0196-0644(05)82971-3

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Study objectives: To determine the sensitivity, specificity, and predictive values of a new rapid creatine kinase-MB (R-CK-MB) assay compared with a standard CK-MB (S-CK-MB) assay and to determine its potential use in the evaluation of emergency department patients with possible myocardial infarction. Design: Retrospective patient identification with subsequent testing of excess sera for CK-MB and total CK using an identity-unlinked procedure. Setting: Large, urban, teaching hospital ED. Participants: All adult patients with excess sera and one of several defined presentations chosen to identify those with possible myocardial ischemia or infarction. Patients with clearly documented noncardiac etiologies of their symptoms or signs were excluded. Main results: The sensitivity, specificity, and positive and negative predictive values of 271 patient specimens for the R-CK-MB assay compared with the S-CK-MB assay were 100%, 96.8%, 75.0%, and 100%, respectively. The R-CK-MB assay was positive for 32 patients (11.8%). Of these, eight (25.0%) were admitted to unmonitored beds, and five (15.6%) were discharged home. All of these 13 patients had initial ECGs without evidence of ischemia or infarction. On follow-up, at least eight of the 13 had evidence of infarction. Conclusion: The R-CK-MB assay demonstrated high sensitivity and specificity compared with the S-CK-MB assay. When used for patients in whom a cardiac care unit admission is not considered, the rapid assay may identify some patients with unsuspected myocardial infarction and prevent inadvertent discharge or admission to unmonitored beds.

引用

页码：954 / 960

页数：7

共 26 条

[1] Tierney, Fitzgerald, McHenry, Et al., Physicians' estimates of the probability of myocardial infarction in emergency room patients with chest pain, Med Decis Making, 6, pp. 12-17, (1986)
[2] Lee, Rouan, Weisberg, Et al., Patients with acute myocardial infarction sent home from the emergency room: Clinical characteristics and natural history, Am J Cardiol, 60, pp. 219-224, (1987)
[3] Eisenberg, Horowitz, Busch, Et al., Diagnosis of acute MI in the emergency room, J Community Health, 4, pp. 190-198, (1979)
[4] Hedges, Rouan, Toltzis, Et al., Use of cardiac enzymes identifies patients with acute MI otherwise unrecognized in the emergency department, Ann Emerg Med, 16, pp. 248-252, (1987)
[5] Wu, Gormet, Harker, Et al., Role of rapid immunoassays for urgent (“stat”) determinations of creatine kinase isoenzyme-MB, Clin Chem, 35, pp. 1752-1756, (1989)
[6] Chan, Taylor, Frye, Et al., Immunoenzymetric assay for creatine kinase MB with subunit-specific monoclonal antibodies compared with an immunochemical method and electrophoresis, Clin Chem, 31, pp. 465-469, (1985)
[7] Vecchio, Predictive value of a single diagnostic test in unselected populations, N Engl J Med, 274, pp. 1171-1173, (1966)
[8] Goldman, Cook, Brand, Et al., A computerderived protocol to predict MI in emergency department patients with chest pain, N Engl J Med, 318, pp. 797-803, (1988)
[9] Pozen, D'Agostino, Mitchell, Et al., The usefulness of a predictive instrument to reduce inappropriate admissions to the CCU, Ann Intern Med, 92, pp. 238-242, (1980)
[10] Tierney, Roth, Psaty, Et al., Predictors of myocardial infarction in emergency room patients, Crit Care Med, 13, pp. 526-531, (1985)

← 1 2 3 →