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Enzymes and long-term survival after first myocardial infarction
Insights
Elevated cardiac enzyme levels, including creatinine phosphokinase (CPK), lactic dehydrogenase (LDH), and glutamic oxaloacetic transaminase (SGOT), after myocardial infarction correlate with higher long-term mortality risk. Higher peak enzyme values indicate a poorer prognosis.
Area of Science:
- Cardiology
- Biochemistry
- Clinical Medicine
Background:
- Myocardial infarction (MI) prognosis is crucial for patient management.
- Cardiac biomarkers play a role in assessing MI severity.
- Long-term outcomes after MI require further investigation.
Purpose of the Study:
- To investigate the relationship between peak serum enzyme levels and long-term prognosis in myocardial infarction survivors.
- To compare the prognostic value of creatinine phosphokinase (CPK), lactic dehydrogenase (LDH), and glutamic oxaloacetic transaminase (SGOT).
Main Methods:
- Serum CPK, LDH, and SGOT levels were measured daily in 342 MI patients during hospitalization.
- Maximum enzyme values were determined for each patient.
- Patients were followed for 12–38 months to assess long-term mortality.
- Enzyme values were analyzed relative to the mean and categorized into four groups.
Main Results:
- Patients with maximum enzyme values at or above the mean exhibited significantly higher 2-year mortality.
- A trend of increasing mortality was observed with higher peak enzyme levels (from next lowest to highest).
- The lowest peak enzyme values showed a tendency towards higher mortality compared to the next lowest group, particularly for CPK and LDH.
Conclusions:
- Peak serum enzyme levels (CPK, LDH, SGOT) are significant predictors of long-term mortality after a first myocardial infarction.
- The relationship between enzyme levels and prognosis is complex, with both very high and very low peak values potentially indicating increased risk.
- These findings support the use of serial cardiac enzyme measurements for prognostic stratification in MI patients.
Abstract:
The study covers 342 patients still alive one month after the acute attack of their first myocardial infarction. Daily determinations of creatinine phosphokinase (CPK), lactic dehydrogenase (LDH) and glutamic oxaloacetic transaminase (SGOT) in serum were carried out during hospitalization, so that a maximum enzyme value could be obtained for each enzyme and patient. A follow-up examination was performed after an observation time ranging from 12 to 38 months. Having calculated the mean (x) of the maximum enzyme values, a parallel relationship was found between the maximum CPK, LDH and SGOT values and the long-term prognosis in myocardial infarction, inasmuch as patients with maximum enzyme values above or equal to the mean had a significantly higher 2-year mortality than patients with values below x. In order to detect any slight difference between the three enzymes with reference to the long-term prognosis, the material was divided into four groups: one with peak values less than x-x/2 (lowest), one with values from x-x/2 to x exclusive (next lowest), one with values from x to x+x/2 exclusive (next highest) and a group with peak elevations greater than or equal to x+x/2 (highest). A tendency to increasing mortality from the next lowest to the highest maximum enzyme values was found. On the other hand, patients with the lowest peak values had a tendency to higher mortality than patients in the next lowest group. This characteristic was observed with regard to both CPK and LDH and to some extent to SGOT.