EXCLUSION OF ACUTE MYOCARDIAL-INFARCTION - THE VALUE OF MEASURING CREATINE-KINASE SLOPE

For the exclusion (and diagnosis) of acute myocardial infarction, we s tudied timed sequential (slope) measurements of creatine kinase and cr eatine kinase-MB catalytic activity concentration, creatine kinase-MB mass concentration, troponin T and myoglobin, using data from 242 pati ents consecutively admitted for evaluation of suspected acute myocardi al infarction in the 12 hours before admission. Three biochemical stra tegies based on measurements in two consecutive samples obtained withi n 12 hours after admission were evaluated. The highest sensitivities w ere encountered for a biochemical strategy based on the sole measureme nt of creatine kinase mass concentration (98%) or troponin T (96%) and a strategy based on measurements of creatine kinase activity concentr ations, which includes creatine kinase slope calculation and measureme nt of creatine kinase mass concentration (95%). Both strategies were a pplied in subgroups of patients based on the electrocardiographic find ings. In patients with a normal electrocardiogram, the sensitivity of the strategy using sole measurements of creatine kinase mass concentra tion was 100%, but this was also true for the strategy based on creati ne kinase slope measurements, which is the cheaper and therefore prefe rred procedure for excluding myocardial infarction. This approach, how ever, does not account for detecting minor myocardial cell damage in p atients not yet fulfilling the criteria of the World Health Organizati on for diagnosing acute myocardial infarction.