Excellent prognosis in patients with unstable angina pectoris classified as “low risk” at admission despite presence of severe coronary artery disease (original) (raw)
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Academic Emergency Medicine, 1997
To determine the test performance characteristics of serial creatine kinase-MB (CK-MB) mass measurements for acute myocardial infarction (MI) in patients presenting to the ED with chest pain and nondiagnostic ECGs. A prospective, observational test performance study was conducted. Hemodynamically stable patients aged > or = 25 years with chest discomfort, but without ECGs diagnostic for MI, were enrolled at 7 university teaching hospitals. Presenting ECGs showing > 1-mV ST-segment elevation in > or = 2 electrically contiguous leads were considered diagnostic for MI; patients with diagnostic ECGs on presentation were excluded. Real-time, serial CK-MB mass levels were obtained using a rapid serum immunochemical assay at the time of ED presentation (0-hour) and 3 hours later (3-hour). The following testing schemes were evaluated for their sensitivity and specificity for detection of MI during patient evaluation in the ED: 1) an elevated (> or = 8 ng/mL) presenting CK-MB level; 2) an elevated presenting and/or 3-hour CK-MB level; 3) a significant increase (i.e., > or = 3 ng/mL) within the range of normal limits for CK-MB concentrations during the 3-hour period (delta CK-MB); and/or 4) development of ST-segment elevation during the 3 hours (second ECG). Of the 1,042 patients enrolled, 777 (74.6%) were hospitalized, including all 67 MI patients (8.6% of admissions). As a function of duration of time in the ED, the test performance characteristics of serial CK-MBs for MI (and cumulative data for the additional ECG) were: [table: see text] The 0-hour to 3-hour CK-MB positive and negative predictive values were 52% to 55% and 96% to 99%, respectively. The sensitivities of serial CK-MB results as a function of the interval following chest discomfort onset were: [table: see text] Serial CK-MB monoclonal antibody mass measurements in the ED can identify MI patients with initially nondiagnostic ECGs. CK-MB sensitivity significantly increases over 3 hours of observation of stable chest discomfort patients in the ED; it also increases as a function of the total interval from onset until enzyme measurement.
Bangladesh Critical Care Journal, 2015
clinical symptoms caused by acute myocardial ischemia. 1,2 ACS encompasses acute myocardial infarction (MI) [both ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI)] and unstable angina (UA). Acute MI is defined as rise of cardiac biomarkers with at least one of the following: ischemic cardiac pain, ECG changes indicative of new ischemia (ST-T change or appearance of new bundle branch block), development of pathological Q waves, imaging evidence of new loss of viable myocardium or new regional wall motion abnormality.UA is diagnosed on the basis of any one of the following criteria: rest angina, new-onset angina, and increasing angina (increasing in intensity, duration, and/or frequency). 3 Many studies have demonstrated that renal insufficiency is an independent risk factor for cardiovascular morbidity and for all-cause as well as cardiovascular death in both the general population and patients with cardiovascular disease. 4 In particular, recent studies have shown that any stage of renal dysfunction (mild to severe) is an independent risk factor for short-and long-term morbidity among patients with MI, even after administration of fibrinolytics. 4-7 However, there are limited data about this relationship in patients presenting with non-ST-segment-elevation MI and unstable angina. 8
Journal of the American College of Cardiology, 2006
We sought to evaluate the association between discordant cardiac marker results and in-hospital mortality and treatment patterns in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). BACKGROUND Creatine kinase-MB (CK-MB) and cardiac troponins (cTn) are often measured concurrently in patients with NSTE ACS. The significance of discordant CK-MB and cTn results is unknown. METHODS Among 29,357 ACS patients in the CRUSADE initiative who had both CK-MB and cTn measured during the first 36 hours, we examined relationships of four marker combinations (CK-MBϪ/cTnϪ, CK-MBϩ/cTnϪ, CK-MBϪ/cTnϩ, and CK-MBϩ/cTnϩ) with mortality and American College of Cardiology/American Heart Association guidelinesrecommended acute care. RESULTS The CK-MB and cTn results were discordant in 28% of patients (CK-MBϩ/cTnϪ, 10%; CK-MBϪ/cTnϩ, 18%). In-hospital mortality was 2.7% among CK-MBϪ/cTnϪ patients; 3.0%, CK-MBϩ/cTnϪ; 4.5%, CK-MBϪ/cTnϩ; and 5.9%, CK-MBϩ/cTnϩ. After adjustment for other presenting risk factors, patients with CK-MBϩ/cTnϪ had a mortality odds ratio (OR) of 1.02 (95% confidence interval [CI] 0.75 to 1.38), those with CK-MBϪ/ cTnϩ had an OR of 1.15 (95% CI 0.86 to 1.54), and those with CK-MBϩ/cTnϩ had an OR of 1.53 (95% CI 1.18 to 1.98). Despite variable risk, patients with CK-MBϩ/cTnϪ and CK-MBϪ/cTnϩ were treated similarly with early antithrombotic agents and catheter-based interventions. CONCLUSIONS Among patients with NSTE ACS, an elevated troponin level identifies patients at increased acute risk regardless of CK-MB status, but an isolated CK-MBϩ status has limited prognostic value. Recognition of these risk differences may contribute to more appropriate early use of antithrombotic therapy and invasive management for all cTnϩ patients.
Journal of the American College of Cardiology, 2002
The study investigated the relationship among creatine kinase (CK) elevations, clinical characteristics and cardiac events across the whole spectrum of acute coronary syndromes (ACS). BACKGROUND Elevated serum levels of cardiac enzymes have been shown to be a major prognostic determinant in acute myocardial ischemia. Yet prior to this report, the relation between cardiac enzyme levels and other prognostic determinants across the entire spectrum of ACS has not been explored by a large clinical study.