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European Heart Journal 1999 20(13):967-972; doi:10.1053/euhj.1998.1449
Copyright © 1999 by the European Society of Cardiology.
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Ruling out acute myocardial infarction early with two serial creatine kinase-MBmassdeterminations

R.J. de Wintera,f1, R. Bholasingha, A.B. Nieuwenhuijsa, R.W. Kostera, R.J.G. Petersa and G.T. Sandersb

a Department of Cardiology, Academic Medical Centre, University of Amsterdam, The Netherlands
b Department of Clinical Chemistry, Academic Medical Centre, University of Amsterdam, The Netherlands

revised November 20, 1998; accepted November 26, 1998

Abstract

Aims We studied the diagnostic value for acute myocardial infarction of serial creatine kinase-MBmassmeasurements on admission and at 7h after the onset of symptoms.

Methods and Results Patients presenting to our chest pain unit with symptoms of <5-h duration were eligible. Patients were kept under observation at least until 12h after onset of symptoms. Blood samples were drawn on admission and 7 and 10h after onset of symptoms. Creatine kinase-MBmass>7·0µg.l–1(upper reference limit for acute myocardial infarction), or an increase >2·0µg.l–1(reference change value) between admission and at 7h was considered abnormal. Of a total of 470 patients, 248 patients had acute myocardial infarction: 100 out of the 248 patients had a single creatine kinase-MBmass>7·0µg.l–1on admission (sensitivity 40%, 95% CI:34–46%), 234/248 patients at 7h (sensitivity 94%, 95% CI:91–97%), and 240/248 at 10h (sensitivity 97%, 95% CI:94–99%). At 7h, 246/248 patients had either a single creatine kinase-MB >7·0µg.l–1or a significant increase between admission and 7h (sensitivity 99%, 95% CI:98–100%). Of 222 patients without acute myocardial infarction, 214 had a normal serial creatine kinase-MBmass(specificity 96%, 95% CI:93–98%).

Conclusion In patients with symptoms of <5-h duration, acute myocardial infarction can be ruled out using serial creatine kinase-MBmasstaken on admission and at 7h.

Key Words: Acute myocardial infarction, cardiac enzymes, creatine kinase MB isoenzyme, diagnosis

f1 Correspondence: Robbert J. de Winter, MD, Department of Cardiology, Rm B2-137, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.


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