Elevated CK-MB with a normal troponin does not predict 30-day adverse cardiac events in emergency department chest pain observation unit patients

Basmah Safdar*, Sarah K. Bezek, Albert J. Sinusas, Raymond R. Russell, Matthew R. Klein, James D. Dziura, Gail D'Onofrio

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background:: Prior studies indicate that an elevated creatinine kinase (CK)-MB imparts poor prognosis in patients with acute coronary syndrome despite a normal troponin. Its prognosis in the undifferentiated chest pain observation unit (CPU) population remains undefined. OBJECTIVE:: To compare rates and predictors of 30-day adverse cardiac events in 2 cohorts (CK±/MB+ vs. normal [CK±/MB-]) in low-moderate-risk CPU patients. METHODS:: Consecutive CPU patients were followed in a retrospective cohort study for primary outcome (acute coronary syndrome, percutaneous transluminal coronary angioplasty, coronary artery bypass graft, abnormal stress test, cardiac hospitalization, or death within 30 days) by using standardized chart reviews and national death registry. Exclusions were: those aged 30 years or younger, positive troponin, ischemic electrocardiogram, hemodynamic instability, heart failure, or dialysis. RESULTS:: Between January 2006 and April 2009, 2979 patients were eligible, of which 350 excluded and 2629 analyzed. MB+ compared with normal patients were more likely to be: older (mean, 53.4 ± 14 vs. 51.5 ± 12 years; P = 0.04); male (71% vs. 40%; P = 0.01); renal insufficient (5% vs. 2%; P = 0.01); hypertensive (50% vs. 44%; P = 0.04); dyslipidemic (44% vs. 33%; P = 0.01) obese (55% vs. 43%; P = 0.01); and with known coronary artery disease (14% vs. 5%; P < 0.01). Composite adverse events were 213 (8%) and did not significantly differ for either initial MB+ vs. normal (9.1%, 8.0%; odds ratio, 1.1, 0.7-1.9) or serial MB+ vs. normal (7.5%, 7.4%; odds ratio, 1.0, 0.5-1.8). In a multiple logistic regression model, male sex, diabetes, and prior CAD predicted adverse events, whereas CK-MB along with race, hypertension, smoking, dyslipidemia, family history, and obesity did not. CONCLUSIONS:: Elevated CK-MB does not add value to serial troponin testing in low-moderate-risk CPU patients.

Original languageEnglish (US)
Pages (from-to)14-19
Number of pages6
JournalCritical Pathways in Cardiology
Volume13
Issue number1
DOIs
StatePublished - Mar 1 2014

Keywords

  • Adverse events
  • Biomarkers
  • Discordant
  • MB fraction
  • Observation unit

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Elevated CK-MB with a normal troponin does not predict 30-day adverse cardiac events in emergency department chest pain observation unit patients'. Together they form a unique fingerprint.

Cite this