Abstract
IntroductionThe diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. The most sensitive and specific biomarkers for cardiac injury are the troponin assays. Many hospitals continue to automatically order less sensitive and less specific biomarkers such as creatine kinase (CK) alongside cardiac troponin (cTn) for workup of patients with chest pain. The objective of this systematic review was to identify whether CK testing is useful in the workup of patients with NSTEMI symptoms.MethodsWe undertook a systematic review to ascertain whether CK ordered as part of the workup for NSTEMI was useful in screening patients with cardiac chest pain. The MEDLINE, Embase, and Cochrane databases were searched from January 1995–September 2020. Additional papers were added after consultation with experts. We screened a total of 2,865 papers, of which eight were included in the final analysis. These papers all compared CK and cTn for NSTEMI diagnosis.ResultsIn each of the eight papers included in the analysis, cTn showed a greater sensitivity and specificity than CK in the diagnosis of NSTEMI. Furthermore, none of the articles published reliable evidence that CK is useful in NSTEMI diagnosis when troponin was negative.ConclusionThere is no evidence to continue to use CK as part of the workup of NSTEMI acute coronary syndrome in undifferentiated chest pain patients. We conclude that CK should not be used to screen patients presenting to the emergency department with chest pain.
Highlights
The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers
In each of the eight papers included in the analysis, cardiac troponin (cTn) showed a greater sensitivity and specificity than creatine kinase (CK) in the diagnosis of NSTEMI
None of the articles published reliable evidence that CK is useful in NSTEMI diagnosis when troponin was negative
Summary
The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. Many hospitals continue to automatically order less sensitive and less specific biomarkers such as creatine kinase (CK) alongside cardiac troponin (cTn) for workup of patients with chest pain. NonST-elevated myocardial infarction constitutes 70% of ACS and is diagnosed using biomarkers.[2,3,4] The biomarkers used to diagnose NSTEMI have evolved greatly over the last 50 years They have changed from the relatively non-specific biomarkers such as aspartate aminotransferase, lactate dehydrogenase, myoglobin, and creatine kinase (CK) (and its cardiac isoform CK-MB) to the very sensitive and specific cardiac troponin assays (TnI, TnT).[5,6] Despite the availability and use of sensitive and specific cardiac troponin (cTn) biomarker assays, many physicians continue to order CK for Volume 22, no. They have changed from the relatively non-specific biomarkers such as aspartate aminotransferase, lactate dehydrogenase, myoglobin, and creatine kinase (CK) (and its cardiac isoform CK-MB) to the very sensitive and specific cardiac troponin assays (TnI, TnT).[5,6] Despite the availability and use of sensitive and specific cardiac troponin (cTn) biomarker assays, many physicians continue to order CK for Volume 22, no. 6: November 2021
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