Creatine kinase-MB does not add additional benefit to a negative troponin in the evaluation of chest pain

Am J Emerg Med. 2012 Jan;30(1):188-90. doi: 10.1016/j.ajem.2010.10.016. Epub 2010 Dec 3.


Objective: The aim of this study was to determine whether current troponin assay alone can be used for initial screening for acute myocardial infarction (AMI) and whether creatine kinase-MB (CK-MB) can safely be eliminated from this evaluation in the emergency department (ED).

Methods: A retrospective cohort study of patients who had cardiac troponin T (Roche, Basel, Switzerland) and CK-MB ordered at an urban academic level 1 trauma center with more than 55,000 annual visits. Patients with troponin testing in the ED were identified over a period of 12 months, and corresponding CK-MB indexes were examined identifying patients with negative troponins (<0.01) and positive CK-MB indexes (>6.0). In these patients, further cardiac markers, hospital course, and 30-day mortality were then evaluated. A 99% confidence interval around point estimate was used in data analysis.

Results: During the study period, there were 11,092 separate ED patient encounters where a patient had at least one troponin resulted. Most (97.9%) of the samples had an associated CK-MB ordered. There were 7545 initial negative troponins representing 68% of all initial samples. Seven of these had an associated positive MB index. When subsequent troponins were evaluated, an additional 4910 negative troponins were identified, with 4 patients having a positive MB. None of these 11 patients were judged to have ruled in for AMI by the treating physicians. The rate of true-positive CK-MB index with negative troponin was 0% (99% confidence interval, 0-0.04%).

Conclusion: Our results suggest that CK-MB is not necessary in the initial screening for AMI and may safely be omitted in patients with negative troponins.

MeSH terms

  • Aged
  • Biomarkers / blood
  • Chest Pain / diagnosis
  • Chest Pain / etiology*
  • Chest Pain / mortality
  • Chi-Square Distribution
  • Confidence Intervals
  • Creatine Kinase, MB Form / blood*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / blood*
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / mortality
  • Predictive Value of Tests
  • Retrospective Studies
  • Trauma Centers / statistics & numerical data
  • Troponin T / blood*


  • Biomarkers
  • Troponin T
  • Creatine Kinase, MB Form