Eliminating Creatine Kinase–Myocardial Band Testing Saves Money, Improves Quality

Creatine kinase–myocardial band (CK-MB) testing provides no incremental value to patient care, and if hospitals and emergency rooms would eliminate its use for evaluating suspected acute coronary syndrome, it could lead to millions of health care dollars saved without adversely affecting patient care, according to a special communication published online Aug. 14 in JAMA Internal Medicine. Since 2000, the American College of Cardiology and the European Society of Cardiology have recognized cardiac troponin (cTn) as the preferred biomarker for assessing myocardial infarctions due to its "nearly absolute" specificity for myocardial tissue and high sensitivity for myocardial injury. CK-MB has higher rates of false positives because, as it can be elevated with skeletal muscle damage. Despite considerable evidence supporting cTn use over CK-MB and institutional efforts to improve testing orders (e.g., institutional guidelines, clinician education efforts, removal of CK-MB from routine order sets, and alerts within the computerized provider order entry system), CK-MB has not yet been eliminated from clinical practice. The College of American Pathologists’ 2013 proficiency survey found that more than three-quarters of U.S. laboratories still use CK-MB. A 2010 study that used National Hospital Ambulatory Medical Care Survey data found that cardiac biomarker testing (both cTn and CK-MB) […]