• Basmah Safdar, Sarah K Bezek, Albert J Sinusas, Raymond R Russell, Matthew R Klein, James D Dziura, and Gail D'Onofrio.
• From the Departments of *Emergency Medicine and ‡Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT; †Department of Emergency Medicine, Baylor School of Medicine, Houston, TX; §Brown University School of Medicine, Providence, RI; and ¶Yale Center for Analytical Sciences, New Haven, CT.
• Crit Pathw Cardiol. 2014 Mar 1;13(1):14-9.

BackgroundPrior studies indicate that an elevated creatinine kinase (CK)-MB imparts poor prognosis in patients with acute coronary syndrome despite a normal troponin. Its prognosis in the undifferentiated chest pain observation unit (CPU) population remains undefined.ObjectiveTo compare rates and predictors of 30-day adverse cardiac events in 2 cohorts (CK ±/MB+ vs. normal [CK ±/MB-]) in low-moderate-risk CPU patients.MethodsConsecutive CPU patients were followed in a retrospective cohort study for primary outcome (acute coronary syndrome, percutaneous transluminal coronary angioplasty, coronary artery bypass graft, abnormal stress test, cardiac hospitalization, or death within 30 days) by using standardized chart reviews and national death registry. Exclusions were: those aged 30 years or younger, positive troponin, ischemic electrocardiogram, hemodynamic instability, heart failure, or dialysis.ResultsBetween January 2006 and April 2009, 2979 patients were eligible, of which 350 excluded and 2629 analyzed. MB+ compared with normal patients were more likely to be: older (mean, 53.4 ± 14 vs. 51.5 ± 12 years; P = 0.04); male (71% vs. 40%; P = 0.01); renal insufficient (5% vs. 2%; P = 0.01); hypertensive (50% vs. 44%; P = 0.04); dyslipidemic (44% vs. 33%; P = 0.01) obese (55% vs. 43%; P = 0.01); and with known coronary artery disease (14% vs. 5%; P < 0.01). Composite adverse events were 213 (8%) and did not significantly differ for either initial MB+ vs. normal (9.1%, 8.0%; odds ratio, 1.1, 0.7-1.9) or serial MB+ vs. normal (7.5%, 7.4%; odds ratio, 1.0, 0.5-1.8). In a multiple logistic regression model, male sex, diabetes, and prior CAD predicted adverse events, whereas CK-MB along with race, hypertension, smoking, dyslipidemia, family history, and obesity did not.ConclusionsElevated CK-MB does not add value to serial troponin testing in low-moderate-risk CPU patients.

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