Study Asserts Creatine Kinase Testing Is Ineffective

A new study suggests that the creatine kinase-myocardial band (CK-MB) test, widely used to evaluate patients with suspected heart attack, is ineffectual.

Researchers at Johns Hopkins University School of Medicine (JHU-SOM; Baltimore, MD, USA) and the Mayo Clinic (Rochester, MN, USA) compiled peer-reviewed evidence from five studies in order to craft a guideline that highlights the need to phase out CK-MB. They also provided a clinical blueprint for doing so, based on U.S. Health Resources & Services Administration (HRSA; Rockville, MD, USA) strategies for implementing quality improvement initiatives.

The new report concludes that CK-MB testing can no longer be considered an effective biomarker for detecting damaged heart muscle, and can be safely eliminated from practice in the clinical setting. The report is the first in a series of peer-reviewed implementation guides co-authored by faculty from the High Value Practice Academic Alliance (HVPAA), a U.S. national coalition created by JHU that includes more than 80 academic institutions, representing 15 medical specialties and subspecialties that are working together to advance quality-driven medicine.

The clinical blueprint includes four steps:
Design and implement a hospital- wide education campaign.
Partner with clinical stakeholders to remove CK-MB from standardized heart disease routine order sets.
Enlist information technology/laboratory staff to create and integrate a best practice alert that appears on any computerized provider order entry system when clinicians order CK-MB.
Measure use of the test and patient care quality and safety outcomes before and after the intervention.

“This article is the first in a series of collaborative multi-institutional publications designed to bridge knowledge to high value practice,” said corresponding author Jeffrey Trost, MD, of JHU-SOM. “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.”

In 2000 the American College of Cardiology (ACC) and the European Society of Cardiology (ESC) identified cardiac troponin as the ideal biomarker due to its high sensitivity for detecting injury to the heart. The 2014 ACC guidelines concluded that CK-MB provides no additional diagnostic value for diagnosing heart attacks. Despite these recommendations, a 2013 survey conducted by the College of American Pathologists found that 77% of nearly 2,000 labs in the United States still use CK-MB as a cardiac damage biomarker. The report was published on August 14, 2017, in JAMA Internal Medicine.

Related Links:
Johns Hopkins University School of Medicine
Mayo Clinic
U.S. Health Resources & Services Administration