Assessment of a creatine kinase-MB/myoglobin kit in the prehospital setting in patients presenting with acute nontraumatic chest pain: the "Shahal" experience.
OBJECTIVE
To evaluate the usefulness of a novel qualitative, rapid, bedside immunoassay device for the detection of elevated creatine kinase MBmass (CK-MB) and myoglobin as a supportive tool for decision-making by the physician who is evaluating patients who present with chest pain.


METHODS
Prospective study.


METHODS
Prehospital (mobile intensive care units).


METHODS
Three hundred twenty-eight consecutive patients, age 71+/-13 yrs (64% males), who were admitted to the hospital via Shahal's mobile intensive care units.


METHODS
During a 6-month period, based on clinical presentations and electrocardiograms, the mobile's physicians classified patients into groups of high or low probability of having an acute myocardial infarction and, thereafter, used a rapid bedside STATus kit (Spectral Diagnostics, Toronto, Ontario, Canada) to determine blood creatine kinase/MB and myoglobin.


RESULTS
Myocardial infarction was confirmed in 59 (18%) patients. If measured >2 hrs after onset, diagnostic sensitivities, specificities, and positive and negative predictive values for physicians were as follows: 71%, 90%, 46%, and 96%, respectively, compared with 100%, 85%, 44%, and 100%, respectively, if assessed by the kit.


CONCLUSIONS
If used 2 to 12 hrs from the onset of symptoms, this device is a convenient diagnostic aid to prevent a misdiagnosis of acute myocardial infarction or unnecessary hospitalization to exclude infarction. This tool may be a promising cost-cutting factor in these days of escalating expenses and dwindling resources.
The Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel. roth_a@netvision.net.il
A
A
Roth
N
N
Malov
Y
Y
Bloch
M
M
Golovner
Y
Y
Slesarenko
R
R
Naveh
E
E
Kaplinsky
S
S
Laniado
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D002637:Chest Pain / Q000209:etiology; D003402:Creatine Kinase / Q000097:blood*; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000145:classification / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood*; D011446:Prospective Studies; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity
D007527:Isoenzymes; D009211:Myoglobin; D011933:Reagent Kits, Diagnostic; D003402:Creatine Kinase