Serum CK-MB in Diagnosis and Assessment of Acute Myocardial Infarction

  • Richard D. White
  • Peer Grande
  • Galen S. Wagner

Abstract

When coronary care units were first developed in the early 1960s, it became important to make a prompt diagnosis regarding presence or absence of an acute myocardial infarct (AMI) to optimize the use of these specialized facilities. This diagnosis was extremely difficult when no new Q waves appeared on the electrocardiogram (ECG) during the first 24–48 h following CCU admission. Total “cardiac” enzyme determinations were an alternative, and when glutamic oxaloacetic transaminase (SGOT), lactic dehydrogenase (LDH), and creatine kinase (CK) all remained within normal limits, the diagnosis of an acute infarct was excluded. However, a variety of other body tissues could be the source of transient elevations of each of these enzymes. The first attempt to specifically identify the tissue of origin of an enzyme was the electrophoretic method for separating the isoenzymes of LDH [1]. This improvement over the use of total LDH was still suboptimal, because (a) an elevation in LDH1 could result from hemolysis as well as from myocardial necrosis, and (b) the results were expressed as ratios of one isoenzyme (LDH1) to another (LDH2) rather than the absolute level of a particular isoenzyme.

Keywords

Ischemia Lactate Electrophoresis Neurol Cardiol 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Moller CE, Raabo E: Diagnostic use of fractionated lactate dehydrogenase activity (LD) in myocardial infarction. Acta Med Scand 175: 31–42, 1964.PubMedCrossRefGoogle Scholar
  2. 2.
    Roe CR, Limbird LE, Wagner GS, Nerenberg ST: Combined isoenzyme analysis in the diagnosis of myocardial injury: application of electrophoretic methods for the detection and quantitation of the creatine phosphokinase MB isoenyzme. J Lab Clin Med 80: 577–590, 1972.PubMedGoogle Scholar
  3. 3.
    Konttinen A, Somer H: Determination of serum creatinekinase isoenzymes in myocardial infarction. Am J Cardiol 29: 817–820, 1972.PubMedCrossRefGoogle Scholar
  4. 4.
    Smith AF: Separation of tissue and serum creatine kinase isoenzymes on polyacryl-amide gel slabs. Clin Chim Acta 39: 351–359, 1972.PubMedCrossRefGoogle Scholar
  5. 5.
    Somer H, Dirbowitz V, Donner M: Creatine kinase isoenzyme in neuromuscular disease. J Neurol Sci 29: 129–136, 1976.PubMedCrossRefGoogle Scholar
  6. 6.
    Goto I, Nagamine M, Katsuki S: Creatine phosphokinase isoenzymes in muscle. Arch Neurol 20: 422–429, 1969.PubMedGoogle Scholar
  7. 7.
    Roberts R, Sobel B: Creatine kinase isoenzymes in the assessment of heart disease. Am Heart J 95: 521–528, 1978.PubMedCrossRefGoogle Scholar
  8. 8.
    Roberts R, Henry PD, Witteveen SAGJ, Sobel BE: Quantification of serum creatine phosphokinase isoenzyme activity. Am J Cardiol 33: 650–654, 1974.PubMedCrossRefGoogle Scholar
  9. 9.
    Wong PC-P, Smith AF: Comparison of 3 methods of analysis of the MB isoenzyme of creatine kinase in serum. Clin Chim Acta 65: 99–107, 1975.PubMedCrossRefGoogle Scholar
  10. 10.
    Grande P, Christiansen C, Naestoft J: Creatine kinase isoenzyme MB assay by electrophoresis. Scand J Clin Lab Invest 39: 207–212, 1979.CrossRefGoogle Scholar
  11. 11.
    Henry PD, Roberts R, Sobel BE: Rapid separation of plasma creatine kinase isoenzymes by batch adsorption on glass beads. Clin Chem 21: 844–849, 1975.PubMedGoogle Scholar
  12. 12.
    Gerhardt W, Ljungdahl L, Borjesson J, Hofven- dahl S, Hedenas B: Creatine kinase B-subunit activity in human serum. I. Development of an immunoinhibition method for routine determination of S-creatine kinase B-subunit activity. Clin Chim Acta 78: 29–41, 1977.PubMedCrossRefGoogle Scholar
  13. 13.
    Roberts R, Parker CW, Sobel BE: Detection of acute myocardial infarction by radioimmunoassay for creatine kinase MB. Lancet 2: 319–322, 1977.PubMedCrossRefGoogle Scholar
  14. 14.
    Wagner GS, Roe CR, Limbird LE, Rosati RA, Wallace AG: The importance of identification of the myocardial-specific isoenzyme of creatine phosphokinase (MB form) in the diagnosis of acute myocardial infarction. Circulation 47: 263–269, 1973.PubMedGoogle Scholar
  15. 15.
    Grande P, Christiansen C, Pedersen A, Christiansen MS: Optimal diagnosis in acute myocardial infarction: a cost-effectiveness study. Circulation 61: 723–728, 1980.PubMedGoogle Scholar
  16. 16.
    Ljungdahl L, Gerhardt W, Hofvendahi S: Serum creatine kinase B subunit activity in diagnosis of acute myocardial infarction. Br Heart J 43: 514–522, 1980.PubMedCrossRefGoogle Scholar
  17. 17.
    Scandinavian Committee on Enzymes: Creatine kinase (EC 2.7.3.2) and creatine kinase B-subunit activity in serum in suspect myocardial infarction: The Nordic Clinical Chemistry Project (NORDKEM), Helsinki, Finland, 1981.Google Scholar
  18. 18.
    Blomberg DJ, Kimber WD, Bürde MD: Creatine kinase isoenzymes: predictive value in the early diagnosis of acute myocardial infarction. Am J Med 59: 464–469, 1975.PubMedCrossRefGoogle Scholar
  19. 19.
    Roark SF, Wagner GS, Izlar HL Jr, Roe CR: Diagnosis of acute myocardial infarction in a community hospital. Circulation 53: 965–969, 1976.PubMedGoogle Scholar
  20. 20.
    Kraft J, Aastrup H, Schroder P: Diagnostic value for acute myocardial infarction of creatine kinase and lactate dehydrogenase isoenzymes compared with total enzymes: creatine kinase isoenzyme specificity for myocardial damage. Acta Med Scand 203: 167–174, 1978.PubMedCrossRefGoogle Scholar
  21. 20.
    Kraft J, Aastrup H, Schroder P: Diagnostic value for acute myocardial infarction of creatine kinase and lactate dehydrogenase isoenzymes compared with total enzymes: creatine kinase isoenzyme specificity for myocardial damage. Acta Med Scand 203: 167–174, 1978.PubMedCrossRefGoogle Scholar
  22. 22.
    Irvin R, Cobb F, Roe C: Acute myocardial infarction and MB creatine phosphokinase. Arch Intern Med 140: 329–334, 1980.PubMedCrossRefGoogle Scholar
  23. 23.
    Shell WE, Kjekshus JK, Sobel BE: Quantitative assessment of the extent of myocardial infarction in the conscious dog by means of analysis of serial changes in serum creatine phosphokinase activity. J Clin Invest 50: 2614–2625, 1971.PubMedCrossRefGoogle Scholar
  24. 24.
    Maroko PR, Kjekshus JK, Sobel BE, Watanabe T, Covell JW, Ross J Jr, Braunwald E: Factors influencing infarct size following experimental coronary artery occlusions. Circulation 43: 67–81, 1971.PubMedGoogle Scholar
  25. 25.
    Rogers WJ, McDaniel HG, Smith LR, Mantle JA, Rüssel RO, Rackley CE: Correlation of angiographic estimates of myocardial infarct size and accumulated release of creatine kinase MB isoenzyme in man. Circulation 56: 199–205, 1977.PubMedGoogle Scholar
  26. 26.
    Yusuf S, Lopez R, Maddison A, Maw P, Ray N, McMillan S, Sleight P: Value of electrocardiogram in predicting and estimating infarct size in man. Br Heart J 42: 283–293, 1979.CrossRefGoogle Scholar
  27. 27.
    Henning H, Schelberg HR, Righetti A, Ash- burn WL, O’Rourke RA: Dual myocardial imaging with technetium-99m pyrophosphate and thallium-201 for detecting, localizing and sizing acute myocardial infarction. Am J Cardiol 40: 147–155, 1977.PubMedCrossRefGoogle Scholar
  28. 28.
    Visser CA, Lie KI, Kan G, Meitzer R, Durrer D: Detection and quantification of acute, isolated myocardial infarction by two dimensional echocardiography. Am J Cardiol 47: 1020–1025, 1981.PubMedCrossRefGoogle Scholar
  29. 29.
    Ter-Pogossian MM, Klein MS, Markham J, Roberts R, Sobel BE: Regional assessment of myocardial metabolic integrity in vivo by positron-emission tomography with 11C-labeled palmitate. Circulation 61: 242–255, 1980.PubMedGoogle Scholar
  30. 30.
    Bleifeld W, Mathey D, Hanrath P, Buss H, Effert S: Infarct size estimated from serial serum Phosphokinase in relation to left ventricular hemodynamics. Circulation 55: 303–311, 1977.PubMedGoogle Scholar
  31. 31.
    Grande P, Hansen BP, Christiansen C, Naestoft J: Estimation of acute myocardial infarct size in man by serum CK-MB measurements. Circulation 65: 756–764, 1982.PubMedCrossRefGoogle Scholar
  32. 32.
    The MILIS Study Group (personal communication)Google Scholar
  33. 33.
    Sobel BE, Brenahan GF, Shell WE, Yoder RD: Estimation of infarct size in man and its relation to prognosis. Circulation 46: 640–648, 1972.PubMedGoogle Scholar
  34. 34.
    Geltman EM, Ehsani AA, Campbell MK, Schechtman K, Roberts R, Sobel BE: The influence of location and extent of myocardial infarction on long-term ventricular dysrhythmia and mortality. Circulation 60: 805–814, 1979.PubMedGoogle Scholar
  35. 35.
    Grande P, Christiansen C, Pedersen A: Influence of acute myocardial infarct size on acute and one-year mortality. Eur Heart J 4: 20–25, 1982.Google Scholar
  36. 35.
    Grande P, Christiansen C, Pedersen A: Influence of acute myocardial infarct size on acute and one-year mortality. Eur Heart J 4: 20–25, 1982.Google Scholar
  37. 37.
    Shell WE, Lavelle JF, Covell FW: Early estimation of myocardial damage in conscious dogs and patients with evolving acute myocardial infarction. J Clin Invest 52: 2579–2590, 1973.PubMedCrossRefGoogle Scholar
  38. 38.
    Shell WE, Sobel BE: Protection of jeopardized ischemic myocardium by reductions of ventricular afterload. N Engl J Med 291: 481–486, 1974.PubMedCrossRefGoogle Scholar
  39. 39.
    Ryan W, Karliner JS, Gilpin EA, CovellJW, De Luca M, Ross J: The creatine kinase curve area and peak creatine kinase after acute myocardial infarction: usefulness and limitations. Am Heart J 101: 162–168, 1981.PubMedCrossRefGoogle Scholar
  40. 40.
    Strauss HD, Sobel BE, Roberts R: The influence of occult right ventricular infarction on enzymatically estimated infarct size, hemodynamics and prognosis. Circulation 62: 503–508, 1980.PubMedGoogle Scholar
  41. 41.
    Marmor A, Geltman EM, Biello DR, Sobel BE, Siegel BA, Roberts R: Functional response of right ventricle to myocardial infarction: defence on the site of left ventricular infarction. Circulation 62: 1005–1011, 1981.CrossRefGoogle Scholar
  42. 42.
    Grande P, Hindman N, Saunamäki K, Wagner GS: Comparison of noninvasive techniques for estimation of myocardial infarct size. (In preparation.)Google Scholar
  43. 43.
    Rentrop P, Blanke H, Karsch KR, et al: Changes in left ventricular function after intracoronary streptokinase infusion in clinically evolving myocardial infarction. Am Heart J 102: 1188–1193, 1981.PubMedCrossRefGoogle Scholar
  44. 44.
    Markis JE, Malagold M, Parker JA, et al: Myocardial salvage after intracoronary thrombolysis with streptokinase in acute myocardial infarction: assessment by intracoronary thallium-201. N Engl J Med 305: 777–782, 1981.PubMedCrossRefGoogle Scholar
  45. 45.
    Vatner SF, Baig H, Manders WT, et al: Effect of coronary artery reperfusion on myocardial infarct size calculated from creatine kinase. J Clin Invest 61: 1048, 1978.PubMedCrossRefGoogle Scholar
  46. 46.
    Jarmakani JM, Limbird L, Graham TC, et al: Effects of reperfusion on myocardial infarct, and the accuracy of estimating infarct size from serum creatine phosphokinase in the dog. Cardiovasc Res 10: 245, 1976.PubMedCrossRefGoogle Scholar
  47. 47.
    Ganz W, Geft I: What is the role of thrombolytic therapy in acute myocardial infarction? Cardiovasc Clin 13: 163–172, 1983.PubMedGoogle Scholar
  48. 48.
    Anderson JL, Marshall HW, Bray BE, et al: A randomized trial of intracoronary streptokinase in the treatment of acute myocardial infarction. N Engl J Med 308: 1312–1318, 1983.PubMedCrossRefGoogle Scholar
  49. 49.
    Schröder R, Biamino G, Leitner E-Rv, et al: Intravenous short-term infusion of streptokinase in acute myocardial infarction. Circulation 67: 536–643, 1983.PubMedCrossRefGoogle Scholar
  50. 50.
    Blanke H, Von Hardenberg D, Cohen M, Kaiser H, Karsch KR, Holt J, Smith H, Rentrop P: Patterns of creatine kinase release during acute myocardial infarction after nonsurgical reperfusion: comparison with conventional treatment and correlation with infarct size. JACC 3: 675–680, 1984.PubMedGoogle Scholar
  51. 51.
    Bresnahan GF, Roberts R, Shell WE, Ross J, Sobel BE: Deleterious effects due to hemorrhage after myocardial reperfusion. Am J Cardiol 33: 82–86, 1974.PubMedCrossRefGoogle Scholar
  52. 52.
    Sharma GP, Hornay G: Serum CPK enzymes in myocardial ischemia followed by reperfusion. In: Fajaddin M, Bhata B, Siddiqui HH, et al (eds) Advances in myocardiology, vol 2. Baltimore: University Park Press, 1980, pp 383–396.Google Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston/Dordrecht/Lancaster 1985

Authors and Affiliations

  • Richard D. White
  • Peer Grande
  • Galen S. Wagner

There are no affiliations available

Personalised recommendations