Incremental value of the leukocyte differential and the rapid creatine kinase-MB isoenzyme for the early diagnosis of myocardial infarction

S. P. Thomson, Raymond J Gibbons, P. A. Smars, Vera Jean Suman, R. V. Pierre, P. J. Santrach, N. S. Jiang

Research output: Contribution to journalArticle

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Abstract

Objective: 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. Design: A prospective, blinded study of these measurements at the time of initial assessment in the emergency department. Setting: Large multispecialty clinic hospital. Patients: 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. Measurements: Automated leukocyte differentials, rapid creatine kinase-MB levels, cortisol levels, and routine clinical measurements. Results: 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% CI, 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% (CI, 52% to 76%); the specificity was 99%; and the positive predictive value was 94% (CI, 82% to 98%). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)335-341
Number of pages7
JournalAnnals of Internal Medicine
Volume122
Issue number5
StatePublished - 1995

Fingerprint

MB Form Creatine Kinase
Lymphopenia
Isoenzymes
Early Diagnosis
Leukocytes
Myocardial Infarction
Hydrocortisone
Hospital Emergency Service
Chest Pain
Infarction
Glucocorticoids
Prospective Studies
Lymphocytes
Wounds and Injuries
Infection
Neoplasms

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Incremental value of the leukocyte differential and the rapid creatine kinase-MB isoenzyme for the early diagnosis of myocardial infarction. / Thomson, S. P.; Gibbons, Raymond J; Smars, P. A.; Suman, Vera Jean; Pierre, R. V.; Santrach, P. J.; Jiang, N. S.

In: Annals of Internal Medicine, Vol. 122, No. 5, 1995, p. 335-341.

Research output: Contribution to journalArticle

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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",
abstract = "Objective: 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. Design: A prospective, blinded study of these measurements at the time of initial assessment in the emergency department. Setting: Large multispecialty clinic hospital. Patients: 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. Measurements: Automated leukocyte differentials, rapid creatine kinase-MB levels, cortisol levels, and routine clinical measurements. Results: 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{\%} CI, 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{\%} (CI, 52{\%} to 76{\%}); the specificity was 99{\%}; and the positive predictive value was 94{\%} (CI, 82{\%} to 98{\%}). Conclusions: 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.",
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T1 - Incremental value of the leukocyte differential and the rapid creatine kinase-MB isoenzyme for the early diagnosis of myocardial infarction

AU - Thomson, S. P.

AU - Gibbons, Raymond J

AU - Smars, P. A.

AU - Suman, Vera Jean

AU - Pierre, R. V.

AU - Santrach, P. J.

AU - Jiang, N. S.

PY - 1995

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N2 - Objective: 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. Design: A prospective, blinded study of these measurements at the time of initial assessment in the emergency department. Setting: Large multispecialty clinic hospital. Patients: 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. Measurements: Automated leukocyte differentials, rapid creatine kinase-MB levels, cortisol levels, and routine clinical measurements. Results: 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% CI, 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% (CI, 52% to 76%); the specificity was 99%; and the positive predictive value was 94% (CI, 82% to 98%). Conclusions: 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.

AB - Objective: 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. Design: A prospective, blinded study of these measurements at the time of initial assessment in the emergency department. Setting: Large multispecialty clinic hospital. Patients: 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. Measurements: Automated leukocyte differentials, rapid creatine kinase-MB levels, cortisol levels, and routine clinical measurements. Results: 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% CI, 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% (CI, 52% to 76%); the specificity was 99%; and the positive predictive value was 94% (CI, 82% to 98%). Conclusions: 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.

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