Cost-effective utilization of CK-MB mass and activity assays

Evaluation of patients with chest pain in the emergency department

Lokinendi V. Rao, John R. Petersen, Amin A. Mohammad, Michael G. Bissell, Anthony Okorodudu

Research output: Contribution to journalArticle

Abstract

Effective use of creatine kinase M and B isoform (CK-MB) test results for the diagnosis or exclusion of acute myocardial infarction (AMI) requires repeated analyses at defined intervals after the onset of chest pain. An increase in serum CK-MB is evaluated relative to typical angina-like chest pain of at least 30 minutes duration and electrocardiographic changes per World Health Organization (WHO) standards. Two or more of the three findings must be abnormal for the diagnosis of AMI. We assessed the appropriateness (clinical usefulness) and cost-effectiveness of CK-MB mass and activity levels in the care of patients with complaints of chest pain seen in our emergency department. The total CK and CK-MB (mass and activity) results for 860 patients during 2 months in 1995 were reviewed retrospectively relative to the discharge diagnosis. According to the discharge diagnoses based on the WHO diagnostic criteria for AMI, only 54 patients (6.3%) had acute myocardial infarction. Three or more CK-MB tests (mass and activity measurements) were performed in 60.5% of patients, and only one test was performed in the remaining 39.5%. Abnormal CK-MB mass or activity was determined with the following criteria: Protocol 1: CK-MB mass >5 ng/mL, total CK >194 U/L, index >2.5%; Protocol 2: CK-MB activity >16 U/L, total CK >65 U/L, index >5%; Protocol 3: CK-MB activity >10 U/L, total CK >65 U/L, index >2.2%. Based on these criteria, CK-MB mass and activity protocols gave positive predictive values of 38.2%, 36.1%, and 35.4% for protocols 1, 2, and 3, respectively. The negative predictive value was 99% for CK-MB mass (Protocol 1), and 98% and 98.9% for CK-MB activity (Protocols 2 and 3). These results indicate that both CK-MB mass and activity protocols have equivalent clinical usefulness. However, given the technologic limitation of two platforms for Protocol 1 vs one assay platform for Protocols 2 and 3, the CK-MB activity protocol is more cost-effective for patient testing in the emergency department laboratory.

Original languageEnglish (US)
Pages (from-to)271-275
Number of pages5
JournalLaboratory Medicine
Volume30
Issue number4
StatePublished - Apr 11 1999

Fingerprint

MM Form Creatine Kinase
Chest Pain
Hospital Emergency Service
Assays
Protein Isoforms
Costs and Cost Analysis
Costs
Myocardial Infarction
Health
Cost effectiveness

ASJC Scopus subject areas

  • Clinical Biochemistry
  • Pathology and Forensic Medicine

Cite this

Cost-effective utilization of CK-MB mass and activity assays : Evaluation of patients with chest pain in the emergency department. / Rao, Lokinendi V.; Petersen, John R.; Mohammad, Amin A.; Bissell, Michael G.; Okorodudu, Anthony.

In: Laboratory Medicine, Vol. 30, No. 4, 11.04.1999, p. 271-275.

Research output: Contribution to journalArticle

Rao, Lokinendi V. ; Petersen, John R. ; Mohammad, Amin A. ; Bissell, Michael G. ; Okorodudu, Anthony. / Cost-effective utilization of CK-MB mass and activity assays : Evaluation of patients with chest pain in the emergency department. In: Laboratory Medicine. 1999 ; Vol. 30, No. 4. pp. 271-275.
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abstract = "Effective use of creatine kinase M and B isoform (CK-MB) test results for the diagnosis or exclusion of acute myocardial infarction (AMI) requires repeated analyses at defined intervals after the onset of chest pain. An increase in serum CK-MB is evaluated relative to typical angina-like chest pain of at least 30 minutes duration and electrocardiographic changes per World Health Organization (WHO) standards. Two or more of the three findings must be abnormal for the diagnosis of AMI. We assessed the appropriateness (clinical usefulness) and cost-effectiveness of CK-MB mass and activity levels in the care of patients with complaints of chest pain seen in our emergency department. The total CK and CK-MB (mass and activity) results for 860 patients during 2 months in 1995 were reviewed retrospectively relative to the discharge diagnosis. According to the discharge diagnoses based on the WHO diagnostic criteria for AMI, only 54 patients (6.3{\%}) had acute myocardial infarction. Three or more CK-MB tests (mass and activity measurements) were performed in 60.5{\%} of patients, and only one test was performed in the remaining 39.5{\%}. Abnormal CK-MB mass or activity was determined with the following criteria: Protocol 1: CK-MB mass >5 ng/mL, total CK >194 U/L, index >2.5{\%}; Protocol 2: CK-MB activity >16 U/L, total CK >65 U/L, index >5{\%}; Protocol 3: CK-MB activity >10 U/L, total CK >65 U/L, index >2.2{\%}. Based on these criteria, CK-MB mass and activity protocols gave positive predictive values of 38.2{\%}, 36.1{\%}, and 35.4{\%} for protocols 1, 2, and 3, respectively. The negative predictive value was 99{\%} for CK-MB mass (Protocol 1), and 98{\%} and 98.9{\%} for CK-MB activity (Protocols 2 and 3). These results indicate that both CK-MB mass and activity protocols have equivalent clinical usefulness. However, given the technologic limitation of two platforms for Protocol 1 vs one assay platform for Protocols 2 and 3, the CK-MB activity protocol is more cost-effective for patient testing in the emergency department laboratory.",
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