Ann Lab Med.  2024 Nov;44(6):586-590. 10.3343/alm.2024.0083.

Limited Contribution of Creatine Kinase-Myocardial Band Alongside High-Sensitivity Cardiac Troponin in Diagnosing Acute Myocardial Infarction in an Emergency Department

• Lee H
• Kang H
• Chae H
• Oh EJ

• KMID: 2560807
• DOI: http://doi.org/10.3343/alm.2024.0083

Abstract

Cardiac biomarkers, especially high-sensitivity cardiac troponin C or I (hs-cTnC or hs-cTnI, respectively), are vital for diagnosing acute myocardial infarction (AMI). Despite the specificity of hs-cTn as a biomarker, the creatine kinase-myocardial band (CK-MB) is commonly used alongside hs-cTn in emergency departments (EDs). We analyzed 23,771 simultaneous hs-cTn (hs-cTnT or hs-cTnI) and CK-MB requests for 17,185 patients in tertiary hospital ED in 2022. The objective of this study was to assess their practical value in diagnosing AMI in real-world settings. Among all 17,185 patients tested, 98.0% underwent hs-cTnT and CK-MB tests, and substantially fewer underwent hs-cTnI testing. We observed concordance between the initial hs-cTn and CK-MB results in 71.3% of patients. Of 131 AMI cases, 57 were positive for both biomarkers, 63 for hs-cTn only, and none for CK-MB alone. CK-MB positivity was often found in the absence of AMI. Discrepancies between the hscTnT and hs-cTnI results occurred in 30.0% of patients. Indiscriminate CK-MB testing for diagnosing AMI in EDs should be reconsidered. Efficient use of CK-MB is important for reducing costs and ensuring optimal patient care.

Keyword

Acute myocardial infarction; Creatine kinase; MB form; High-sensitivity cardiac troponin

Figure

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  Fig. 1 Comparison of hs-cTnT and CK-MB levels in 16,836 patients who visited tertiary hospital emergency department over 1 yr. (A) In AMI and non-AMI patients, CK-MB-positive patients had higher hs-cTnT levels than CK-MB-negative patients (AMI; median 0.366 vs. 0.038 ng/mL [P<0.0001], non-AMI; 0.042 vs. 0.008 ng/mL [P<0.0001]). (B) In patients with or without AMI, hs-cTnT-positive patients had higher CK-MB levels than hs-cTnT-negative patients (AMI; 4.78 vs. 0.79 ng/mL [P<0.0001], non-AMI; 1.18 vs. 0.40 ng/mL [P<0.0001]). A minus sign indicates the biomarker concentration is within the reference limit, while a plus sign shows it has exceeded the limit. Abbreviations: hs-cTnT, high-sensitivity cardiac troponin T; CK-MB, creatine kinase- myocardial band; AMI, acute myocardial infarction.

Reference

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