CK-MB of no diagnostic value in diagnosing suspected MI

By Liz Meszaros, MDLinx
Published August 18, 2017

Key Takeaways

Creatine kinase-myocardial band (CK-MB) is no longer an effective biomarker for detecting damaged myocardial tissue, and therefore, testing can be safely eliminated from practice in the evaluation of patients with suspected myocardial infarction (MI), according to researchers at the Johns Hopkins University School of Medicine, Baltimore, MD, and the Mayo Clinic, Rochester, MN, and faculty from the High Value Practice Academic Alliance (HVPAA).

Their report, published in JAMA Internal Medicine, is the first in a series of peer-reviewed implementation guides coauthored by faculty from the HVPAA, a national coalition formed by The Johns Hopkins University School of Medicine, and includes faculty from over 80 academic institutions, from 15 medical specialties/subspecialties. Their goal is to advance quality-driven value improvement.

“This article is the first in a series of collaborative multi-institutional publications designed to bridge knowledge to high value practice. We present multiple quality improvement initiatives that safely eliminated CK-MB to give providers reassurance about trusting troponin levels when managing patients with suspected acute coronary syndrome,” said Jeffrey Trost, MD, assistant professor of medicine, Johns Hopkins University School of Medicine.

Since 2014, guidelines from the American Heart Association/American College of Cardiology have concluded that CK-MB provides no additional diagnostic value in diagnosing heart attacks. And since 2000, the American College of Cardiology and the European Society of Cardiology declared troponin to be the ideal biomarker for detection of myocardial injury due to its high sensitivity. Despite this, 1 survey conducted by the College of American Pathologists in 2013 found that 77% of nearly 2,000 labs in the US still used CK-MG as a biomarker of cardiac damage.

The clinical and financial implications of continuing CK-MB testing are significant, according to Dr. Trost and fellow researchers. They estimate that blood tests for diagnosing heart attacks can add as much as $416 million each year to the cost of care.

Troponin is not only of diagnostic value, but is also a more definitive predictor of in-hospital mortality and disease severity as well.

According to Dr. Trost, the new report highlights the need to phase out CK-MB and provides a blueprint for doing so based on strategies from the US Health Resources & Services Administration for implementing any quality improvement initiative. Steps to do so should include the following:

  • Design and implement a hospital-wide education campaign.
  • Partner with clinical stakeholders in cardiology, emergency medicine, internal medicine, and laboratory/pathology, to remove CK-MB from standardized heart disease routine order sets.
  • Enlist IT and laboratory medicine staff to create and integrate a best practice ‘alert’ that appears on any computerized provider order entry systems when clinicians order CK-MB.
  • Measure use of the test and patient care quality and safety outcomes both before and after the intervention.

For more information, go to the HVPAA website.

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