Bedside measurement of creatine kinase to guide thrombolysis on the coronary care unit.

Thrombolysis is effective in treating patients with acute myocardial infarction when started within 12 h of onset, and thus is in widespread use. Early diagnosis is essential but some patients admitted to the coronary care unit with myocardial infarction do not meet the diagnostic criteria on arrival, and thus do not undergo thrombolysis. We studied 117 patients admitted consecutively to our coronary care unit with suspected but unproven myocardial infarction; normally none would have received thrombolytic agents. In each patient creatine kinase levels were measured on admission and after intervals by nurses using capillary blood samples and a dry chemistry system. Infarction was subsequently confirmed in 29 patients. Of these, 17 (59%) were correctly diagnosed and underwent thrombolysis within 12 h on the basis of a raised creatine kinase measured at the bedside. Our findings suggest that use of a bedside assay by nurses allows additional patients with myocardial infarction to receive the benefit of thrombolytic therapy within the first 12 h.