TY - JOUR
T1 - Incremental value of the leukocyte differential and the rapid creatine kinase-MB isoenzyme for the early diagnosis of myocardial infarction
AU - Thomson, Stephen P.
AU - Gibbons, Raymond J.
AU - Smars, Peter A.
AU - Suman, Vera J.
AU - Pierre, Robert V.
AU - Santrach, Paula J.
AU - Jiang, Nai Siang
PY - 1995/3
Y1 - 1995/3
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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U2 - 10.7326/0003-4819-122-5-199503010-00003
DO - 10.7326/0003-4819-122-5-199503010-00003
M3 - Article
C2 - 7847644
AN - SCOPUS:0028911150
SN - 0003-4819
VL - 122
SP - 335
EP - 341
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 5
ER -