title: Contribution of creatine kinase MB mass concentration at admission to early diagnosis of acute myocardial infarction.
abstract: OBJECTIVE
  To assess the diagnostic value at admission of creatine kinase MB mass concentration, alone or in combination with electrocardiographic changes, in suspected myocardial infarction.
  
  
  METHODS
  Prospective study of all consecutive patients admitted within 12 hours after onset of chest pain to a coronary care unit for evaluation of suspected myocardial infarction.
  
  
  METHODS
  Large regional hospital.
  
  
  METHODS
  In 297 patients creatine kinase and creatine kinase MB activities and creatine kinase MB mass concentration were determined. Myocardial infarction according to the criteria of the World Health Organisation was diagnosed in 154 patients and excluded in 143 patients (including 70 with unstable angina pectoris).
  
  
  RESULTS
  Sensitivity/specificity for creatine kinase MB mass concentration in patients admitted within 4 hours and 4-12 hours after onset of chest pain were 45%/94% and 76%/79% respectively. Corresponding values for creatine kinase activity were 20%/89% and 59%/83%, and for creatine kinase MB activity 16%/87% and 53%/87%. Raised creatine kinase MB mass concentration was seen in 17% of patients with unstable angina pectoris. Stepwise logistic regression analysis showed that independent predictors of acute myocardial infarction in patients admitted within 4 hours after onset of chest pain were electrocardiographic changes and creatine kinase MB mass concentration on admission; in patients admitted 4-12 hours after the onset of pain independent predictors were electrocardiographic changes and creatine kinase MB mass concentration and activity.
  
  
  CONCLUSIONS
  Creatine kinase MB mass concentration is a more sensitive marker for myocardial infarction than the activity of creatine kinase and its MB isoenzyme. Electrocardiographic changes on admission in combination with creatine kinase MB mass concentration (instead of creatine kinase and creatine kinase MB activities) are best in diagnosing myocardial infarction.
authors.affiliation: Department of Clinical Chemistry, Klinisch Chemisch Laboratorium, Leeuwarden, The Netherlands.
authors.forename: A J
authors.initials: AJ
authors.lastname: Bakker
authors.forename: J P
authors.initials: JP
authors.lastname: Gorgels
authors.forename: B
authors.initials: B
authors.lastname: van Vlies
authors.forename: M J
authors.initials: MJ
authors.lastname: Koelemay
authors.forename: R
authors.initials: R
authors.lastname: Smits
authors.forename: J G
authors.initials: JG
authors.lastname: Tijssen
authors.forename: F D
authors.initials: FD
authors.lastname: Haagen
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000201:enzymology; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood*; D004562:Electrocardiography; D005260:Female; D006331:Heart Diseases / Q000201:enzymology; D006801:Humans; D007124:Immunoenzyme Techniques; D007527:Isoenzymes; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000201:enzymology; D011446:Prospective Studies; D012016:Reference Values; D012044:Regression Analysis; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D003402:Creatine Kinase