Clinical Chemistry, Vol 35, 1435-1440, Copyright © 1989 by American Association for Clinical Chemistry

Re-evaluation of the diagnostic utility of serum total creatine kinase and creatine kinase-2 in myocardial infarction [published errata appear in Clin Chem 1989 Nov;35(11):2257 and 1990 Aug;36(8 Pt 1):1530]

FY Leung, LV Galbraith, G Jablonsky and AR Henderson
Department of Clinical Biochemistry, University Hospital (University of Western Ontario), London, Canada.

The diagnostic utility of total creatine kinase activity (I), creatine kinase-2 isoenzyme activity (II), and II as a percentage of I, was examined by receiver-operating characteristic curve and likelihood ratio (LR) analyses in 310 persons admitted to the Coronary Care Unit (151 proven cases of myocardial infarction and 159 non-myocardial infarction controls), from whom blood was sampled at 6-h intervals for 48 h after the onset of chest pain. I was ineffective either as a "rule- in" or as a "rule-out" test within the first 6 h of the onset of chest pain; thereafter, it was an effective test. II was the most effective test during the entire 48-h period. III was more effective than I in the first 24-h period, but was less effective than I during the next 24- h period. The decision threshold for high test sensitivities varies with time over the entire 48-h period, but remains constant for high test specificities. It is essential to tabulate the LR(+) and LR(-) values for both test sensitivity and specificity at constant values to determine the utility of each test at each time interval for respectively ruling out or ruling in a diagnosis of myocardial infarction.

The following articles in journals at HighWire Press have cited this article:

				P O Collinson, P J Stubbs, and A-C Kessler Multicentre evaluation of the diagnostic value of cardiac troponin T, CK-MB mass, and myoglobin for assessing patients with suspected acute coronary syndromes in routine clinical practice Heart, March 1, 2003; 89(3): 280 - 286. [Abstract] [Full Text] [PDF]