SERIAL ECGS ARE LESS ACCURATE THAN SERIAL CK-MB RESULTS FOR EMERGENCY DEPARTMENT DIAGNOSIS OF MYOCARDIAL-INFARCTION

被引：81

作者：

HEDGES, JR

YOUNG, GP

HENKEL, GF

GIBLER, WB

GREEN, TR

SWANSON, JR

机构：

[1] Department of Emergency Medicine, Portland Veterans Medical Affairs Center, Portland, OR

[2] Oregon Health Sciences University Portland Veterans Medical Affairs Center, Portland, OR

[3] Emergency Services, Portland Veterans Medical Affairs Center, Portland, OR

[4] Clinical Chemistry Laboratory, Portland Veterans Medical Affairs Center, Portland, OR

[5] Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH

来源：

ANNALS OF EMERGENCY MEDICINE | 1992年 / 21卷 / 12期

关键词：

D O I：

10.1016/S0196-0644(05)80057-5

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Hypothesis: Serial creatine kinase-MB (CK-MB) levels provide more accurate predictive information regarding myocardial infarction than serial ECGs in emergency department patients with chest discomfort and no ST-segment elevation on the initial ECG. Design: Prospective, observational study. Setting: University hospital and university-affiliated Veterans Affairs Medical Center EDs. Participants: Two hundred sixty-one patients 30 years or older with chest discomfort warranting an ECG and consenting to observation. Exclusions included hemodynamic or rhythm instability and ST-segment elevation of 0.1 mV or more in two or more electrically contiguous leads at presentation. Measurements: ECGs were obtained at presentation and three to four hours after presentation. Significant serial ECG changes sought on comparison of initial and three- to four-hour ECGs were 0.05 mV or more ST elevation or depression, Q-wave development, or T-wave inversion changes in two or more electrically contiguous leads. CK-MB levels were obtained at presentation and hourly for three hours (positive level, 8 or more ng/mL). Myocardial infarction was determined by record review and was based on independent CK-MB measurements. Results: Twenty-eight (11%) patients were diagnosed with a myocardial infarction. Thirty-eight (15%) patients had a serial ECG change. Eleven of the myocardial infarction patients (39%) had a serial ECG change compared with 27 (12%) of the non-myocardial infarction patients (P < .001). Sensitivities and specificities of a serial ECG change versus serial CK-MBs for myocardial infarction were 39% versus 68% (sensitivity) and 88% versus 95% (specificity), respectively. Serial CK-MBs were more accurate than a serial ECG change for predicting myocardial infarction (P < .03). Conclusion: Serial changes in ECGs during a three- to four-hour interval were associated with the diagnosis of myocardial infarction but were infrequent and less accurate than serial CK-MB levels obtained for the same interval.

引用

页码：1445 / 1450

页数：6

共 26 条

[1]

Behar, Scher, Karix, Et al., Evaluation of the electrocardiogram in the emergency room as a decision making tool, Chest, 71, pp. 486-491, (1977)

[2]

Rude, Poole, Muller, Et al., Electrocardiographic and clinical criteria for recognition of acute myocardial infarction based on analysis of 3,697 patients, Am J Cardiol, 52, pp. 936-942, (1983)

[3]

Lee, Weisberg, Brand, Et al., Candidates for thrombolysis among emergency room patients with acute chest pain: Potential true- and false-positive rates, Ann Intern Med, 110, pp. 957-962, (1989)

[4]

Hedges, Rouan, Toltzis, Et al., Use of cardiac enzymes identifies patients with acute myocardial infarction otherwise unrecognized in the emergency department, Ann Emerg Med, 16, pp. 248-252, (1987)

[5]

Green, Hansen, Chan, Et al., The potential utility of a rapid CK-MB assay in evaluating emergency department patients with possible myocardial infarction, Ann Emerg Med, 20, pp. 954-960, (1991)

[6]

Gibler, Lewis, Erb, Et al., Early detection of acute myocardial infarction in patients presenting with chest pain and nondiagnostic ECGs: Serial CK-MB sampling in the emergency department, Ann Emerg Med, 19, pp. 1359-1366, (1990)

[7]

Gibler, Young, Hedges, Et al., AMI detection in chest pain patients with non-diagnostic ECGs Serial CK-MB sampling in the emergency department, Annals of Emergency Medicine, 21, pp. 504-512, (1992)

[8]

Young, Hedges, Gibler, Et al., Do CK-MB results affect chest pain decision making in the emergency department?, Ann Emerg Med, 20, pp. 1220-1228, (1991)

[9]

Marin, Teishman, Utility of serial creatine kinase MB levels during initial assessment of acute chest pain, Journal of the American College of Cardiology, 17, (1991)

[10]

Selker, Griffith, D'Agostino, A tool for judging coronary care unit admission appropriateness, valid for both real-time and retrospective use, Med Care, 29, pp. 610-627, (1991)

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