Background:
The current consensus guidelines of the American College of Cardiology state that troponins (TnT or TnI) are the preferred biomarkers of myocardial necrosis to evaluate patients with chest pain syndrome to make the diagnosis of acute coronary syndrome (ACS). Many facilities and clinicians elect to continue to include CK and CK‐MB with troponins because in their opinion these tests either enhance or better define patients with acute coronary syndrome. This is the practice in our hospital, and it unclear whether this practice with its increased cost improves the standard of care for our patients.
Methods:
Data were obtained in a retrospective review of medical records of patients admitted to our institution from January to March of 2006 with a diagnosis of chest pain, atypical chest pain, or ACS. We evaluated a total of 350 charts for this study.
Results:
The 350 charts selected were those of 271 men (77%) and 79 women (23%), whose mean age was 65.27 years. One hundred and sixty‐one patients (46%) had positive biomarkers: 147 (91%) were troponin I (Trop I) positive, 94 (58%) were CK‐MB positive, and 14 (9%) were CK positive. Eighty patients (49%) had elevated Trop I with normal CK and CK‐MB, 67 (42%) had elevated Trop I with elevated CK and CK‐MB, and 14 (9%) had normal Trop I with elevated CK and CK‐MB.
Conclusions:
In our study, we found no patient diagnosed with either ACS or acute myocardial infarction who did not have elevated troponin. A small number of patients admitted with chest pain had either elevated CK or elevated CK‐MB with normal troponin. All these received an alternative diagnosis (rhabdomyolysis, CRF/ESRD). Elevation of CK and CK‐MB with elevated troponin did not lead to a different management strategy. In our institution the continued use of CK and CK‐MB for patients admitted with chest pain did not add to the management or diagnosis but substantially increased the cost.
Author Disclosure:
J. D. Jayes, None; J. F. Hanley, None.