title: Critical difference between serial measurements of CK-MB mass to detect myocardial damage.
abstract: To assess the critical difference in serial measurements of CK-MBmass and the ability of this critical difference to detect myocardial damage, we studied 110 patients in whom an acute myocardial infarction (AMI) had been ruled out. Blood samples were drawn at 3, 4, 5, 6, 7, 8, 12, 16, 20, and 24 h after onset of symptoms. With a critical difference of 72.6%, an increase of >2.0 microg/L between two CK-MBmass measurements was determined to be significant. Twenty-three of the non-AMI patients had an increase in CK-MBmass >2.0 microg/L, but five of these did not have an abnormal concentration of troponin T (i.e., not >0.1 microg/L). Also among the 110 non-AMI patients, 22 did have an abnormal troponin T value, 18 of whom (82%) also had CK-MBmass increased by >2.0 microg/L. In 20 of the 23 patients with an increase in CK-MBmass >2.0 microg/L, this increase was detected from the values for two samples collected at 5 and 12 h after onset of symptoms. In conclusion, using the critical difference for CK-MBmass defined as an increase >2.0 microg/L detected myocardial damage in patients without AMI.
authors.affiliation: Academic Medical Center, Department of Cardiology, University of Amsterdam, The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: de Winter
authors.forename: R W
authors.initials: RW
authors.lastname: Koster
authors.forename: J P
authors.initials: JP
authors.lastname: van Straalen
authors.forename: J P
authors.initials: JP
authors.lastname: Gorgels
authors.forename: F J
authors.initials: FJ
authors.lastname: Hoek
authors.forename: G T
authors.initials: GT
authors.lastname: Sanders
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain; D003402:Creatine Kinase / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007527:Isoenzymes; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000201:enzymology*; D009206:Myocardium / Q000201:enzymology*; D014336:Troponin / Q000097:blood; D020107:Troponin T
chemical_list: D007527:Isoenzymes; D014336:Troponin; D020107:Troponin T; D003402:Creatine Kinase