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- Title
Incremental value of the leukocyte differential and the rapid creatine kinase-MB isoenzyme for the early diagnosis of myocardial infarction.
- Authors
Thomson SP; Gibbons RJ; Smars PA; Suman VJ; Pierre RV; Santrach PJ; Jiang NS; Thomson, S P; Gibbons, R J; Smars, P A; Suman, V J; Pierre, R V; Santrach, P J; Jiang, N S
- Abstract
<bold>Objective: </bold>To test whether automated measurements of cortisol-induced changes in the leukocyte differential can provide an early marker of myocardial infarction, especially when combined with the rapid creatine kinase-MB isoenzyme.<bold>Design: </bold>A prospective, blinded study of these measurements at the time of initial assessment in the emergency department.<bold>Setting: </bold>Large multispecialty clinic hospital.<bold>Patients: </bold>511 consecutive patients presenting to the emergency department with chest pain. One hundred twenty-seven patients with infection, trauma, or metastatic cancer or receiving myelosuppressive or glucocorticoid therapy were excluded.<bold>Measurements: </bold>Automated leukocyte differentials, rapid creatine kinase-MB levels, cortisol levels, and routine clinical measurements.<bold>Results: </bold>Of 69 patients with myocardial infarction, only 39% had diagnostic electrocardiographic ST-segment elevation. ST-segment elevation had a specificity of 99% and a positive predictive value of 93%. A relative lymphocytopenia (lymphocyte decrease < 20.3%) or elevated rapid creatine kinase-MB level (> 4.7 ng/mL) was more sensitive than ST-segment elevation (sensitivities of 58% and 56%, respectively) but less specific (specificities of 91% and 93%, respectively). The presence of both a relative lymphocytopenia and an elevated rapid creatine kinase-MB level had a sensitivity of 44%, a specificity of 99.7%, and a positive predictive value of 97% (95% Cl, 80% to 99%). Both a relative lymphocytopenia and an elevated rapid creatine kinase-MB level were independent (P < 0.001) predictors of infarction in patients without ST-segment elevation. If myocardial infarction was suspected by the presence of both abnormal markers or ST-segment elevation, the sensitivity for early diagnosis increased from 39% (ST elevation alone) to 65% (Cl, 52% to 76%); the specificity was 99%; and the positive predictive value was 94% (Cl, 82% to 98%).<bold>Conclusions: </bold>The presence of both a relative lymphocytopenia and an elevated rapid creatine kinase-MB level was an accurate early marker of myocardial infarction that appeared to improve the sensitivity of early diagnosis compared with that of ST-segment elevation alone.
- Publication
Annals of Internal Medicine, 1995, Vol 122, Issue 5, p335
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-122-5-199503010-00003