DOUBLING OF CK-MB PREDICTS INCREASED COMPLICATION RATE IN SUSPECTED ACUTE CORONARY SYNDROME PATIENTS

Peacock, W. et al. Acad Emerg Med Volume 7, Number 5 457 (ABSTRACT)

OBJECTIVE: To evaluate outcomes in ED suspected acute coronary syndrome patients with CK-MB doubling during serial testing. Design: Prospective longitudinal study. Setting: 1,000 bed urban tertiary referral teaching hospital with a 40,000 visit ED. Participants: A 1 year convenience sample of all ED patients admitted to the hospital for a suspected acute coronary syndrome.

METHODS: CK-MB was measured at 0, 4, 8, & 16 hours post-ED admission. CK-MB doubling was based on the first CK-MB. Complications were defined as death, MI, unstable angina, PTCA, or open heart surgery. Normal CK-MB was defined as < 8.8 ng/mL. Outcomes were determined by chart review and 6 month phone follow up. Reviewers were blinded to the study results.

RESULTS: 699 ED suspected acute coronary syndrome patients were entered. Mean time to ED presentation was 5 hours after symptom onset. 41 patients doubled their CK-MB during serial testing. 51.2% of CK-MB doublers had an acute complication compared to an acute complication rate of only 21.9% in non-doublers (p=0.001). The 6 month complication rate (10%) was not different between groups (p=0.35).

CONCLUSIONS: CK-MB doubling in ED suspected acute coronary syndrome patients predicts a high acute complication risk.