Role of Creatine Kinase in the Troponin Era: A Systematic Review

Introduction: The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. The most sensitive and specific biomarkers for cardiac injury are the troponin assays. Many hospitals continue to automatically order less sen...

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Autores principales:	Daniel Beamish, Tetyana Maniuk, Muhammad Mukarram, Venkatesh Thiruganasambandamoorthy
Formato:	article
Lenguaje:	EN
Publicado:	eScholarship Publishing, University of California 2021
Materias:	Medicine R Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/44799d6d9e7b45648a1865a005954c6c
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spelling	oai:doaj.org-article:44799d6d9e7b45648a1865a005954c6c2021-11-17T15:19:27ZRole of Creatine Kinase in the Troponin Era: A Systematic Review1936-901810.5811/westjem.2020.11.47709https://doaj.org/article/44799d6d9e7b45648a1865a005954c6c2021-09-01T00:00:00Zhttps://escholarship.org/uc/item/1950b7rshttps://doaj.org/toc/1936-9018Introduction: The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. The most sensitive and specific biomarkers for cardiac injury are the troponin assays. Many hospitals continue to automatically order less sensitive and less specific biomarkers such as creatine kinase (CK) alongside cardiac troponin (cTn) for workup of patients with chest pain. The objective of this systematic review was to identify whether CK testing is useful in the workup of patients with NSTEMI symptoms. Methods: We undertook a systematic review to ascertain whether CK ordered as part of the workup for NSTEMI was useful in screening patients with cardiac chest pain. The MEDLINE, Embase, and Cochrane databases were searched from January 1995–September 2020. Additional papers were added after consultation with experts. We screened a total of 2,865 papers, of which eight were included in the final analysis. These papers all compared CK and cTn for NSTEMI diagnosis. Results: In each of the eight papers included in the analysis, cTn showed a greater sensitivity and specificity than CK in the diagnosis of NSTEMI. Furthermore, none of the articles published reliable evidence that CK is useful in NSTEMI diagnosis when troponin was negative. Conclusion: There is no evidence to continue to use CK as part of the workup of NSTEMI acute coronary syndrome in undifferentiated chest pain patients. We conclude that CK should not be used to screen patients presenting to the emergency department with chest pain.Daniel BeamishTetyana ManiukMuhammad MukarramVenkatesh ThiruganasambandamoorthyeScholarship Publishing, University of CaliforniaarticleMedicineRMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENWestern Journal of Emergency Medicine, Vol 22, Iss 6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medicine R Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Daniel Beamish Tetyana Maniuk Muhammad Mukarram Venkatesh Thiruganasambandamoorthy Role of Creatine Kinase in the Troponin Era: A Systematic Review
description	Introduction: The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. The most sensitive and specific biomarkers for cardiac injury are the troponin assays. Many hospitals continue to automatically order less sensitive and less specific biomarkers such as creatine kinase (CK) alongside cardiac troponin (cTn) for workup of patients with chest pain. The objective of this systematic review was to identify whether CK testing is useful in the workup of patients with NSTEMI symptoms. Methods: We undertook a systematic review to ascertain whether CK ordered as part of the workup for NSTEMI was useful in screening patients with cardiac chest pain. The MEDLINE, Embase, and Cochrane databases were searched from January 1995–September 2020. Additional papers were added after consultation with experts. We screened a total of 2,865 papers, of which eight were included in the final analysis. These papers all compared CK and cTn for NSTEMI diagnosis. Results: In each of the eight papers included in the analysis, cTn showed a greater sensitivity and specificity than CK in the diagnosis of NSTEMI. Furthermore, none of the articles published reliable evidence that CK is useful in NSTEMI diagnosis when troponin was negative. Conclusion: There is no evidence to continue to use CK as part of the workup of NSTEMI acute coronary syndrome in undifferentiated chest pain patients. We conclude that CK should not be used to screen patients presenting to the emergency department with chest pain.
format	article
author	Daniel Beamish Tetyana Maniuk Muhammad Mukarram Venkatesh Thiruganasambandamoorthy
author_facet	Daniel Beamish Tetyana Maniuk Muhammad Mukarram Venkatesh Thiruganasambandamoorthy
author_sort	Daniel Beamish
title	Role of Creatine Kinase in the Troponin Era: A Systematic Review
title_short	Role of Creatine Kinase in the Troponin Era: A Systematic Review
title_full	Role of Creatine Kinase in the Troponin Era: A Systematic Review
title_fullStr	Role of Creatine Kinase in the Troponin Era: A Systematic Review
title_full_unstemmed	Role of Creatine Kinase in the Troponin Era: A Systematic Review
title_sort	role of creatine kinase in the troponin era: a systematic review
publisher	eScholarship Publishing, University of California
publishDate	2021
url	https://doaj.org/article/44799d6d9e7b45648a1865a005954c6c
work_keys_str_mv	AT danielbeamish roleofcreatinekinaseinthetroponineraasystematicreview AT tetyanamaniuk roleofcreatinekinaseinthetroponineraasystematicreview AT muhammadmukarram roleofcreatinekinaseinthetroponineraasystematicreview AT venkateshthiruganasambandamoorthy roleofcreatinekinaseinthetroponineraasystematicreview
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Role of Creatine Kinase in the Troponin Era: A Systematic Review

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