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Are enzymatic tests good indicators of coronary reperfusion?
H A Bosker1, A van der Laarse, V M Cats
1Department of Cardiology, University Hospital Leiden, The Netherlands.
Insights
Enzymatic tests for creatine kinase and alpha-hydroxybutyrate dehydrogenase do not reliably indicate coronary reperfusion after thrombolysis. These markers showed low accuracy in predicting successful treatment outcomes in acute myocardial infarction patients.
Area of Science:
- Cardiology
- Biochemistry
- Medical Diagnostics
Background:
- Thrombolytic therapy is crucial for acute myocardial infarction.
- Assessing coronary reperfusion non-invasively is clinically important.
- Enzymatic markers are potential indicators of reperfusion.
Purpose of the Study:
- To evaluate the accuracy of four enzymatic tests in assessing coronary reperfusion post-thrombolysis.
- Specifically, to analyze early release rates of creatine kinase and alpha-hydroxybutyrate dehydrogenase.
Main Methods:
- Prospective clinical trial involving 89 acute myocardial infarction patients.
- All patients initially had a closed infarct-related artery.
- Coronary reperfusion was confirmed by arteriography in 74 patients; 15 showed no reperfusion.
Main Results:
- Patients with reperfusion had faster peak creatine kinase activity and higher early release rates for both creatine kinase and alpha-hydroxybutyrate dehydrogenase.
- A more rapid release of alpha-hydroxybutyrate dehydrogenase was also observed in reperfused patients (p < 0.001).
- However, the accuracy of the four enzymatic tests ranged only from 70% to 82%.
Conclusions:
- The studied enzymatic tests are not accurate predictors of coronary artery perfusion status after thrombolysis.
- These markers lack reliability for routine clinical use as non-angiographic indicators of reperfusion.
- Further research may be needed to identify more precise non-invasive markers.
Objective:
To assess the accuracy of four enzymatic tests, including early release rates of creatine kinase and alpha-hydroxybutyrate dehydrogenase, in assessing coronary reperfusion after thrombolytic therapy.
Design:
A prospective clinical trial identifying patients with a successful thrombolytic treatment.
Patients:
Eighty nine patients with acute myocardial infarction were studied. Arteriography showed a closed infarct related artery in all of them. Reperfusion due to thrombolysis occurred in 74 patients and there was no reperfusion in 15 patients.
Results:
The 74 patients showing coronary reperfusion had a significantly shorter time to peak creatine kinase activity, higher early release rates for creatine kinase and alpha-hydroxybutyrate dehydrogenase, and a more rapid release of alpha-hydroxybutyrate dehydrogenase (ratio of cumulative release of alpha-hydroxybutyrate dehydrogenase during the first 24 hours to that 72 hours after infarction). All these differences were statistically significant (p less than 0.001). Optimum cut off levels were determined with decision level plots and the accuracy of the four enzymatic tests was calculated. Accuracy was low for all four tests (73%, 70%, 70%, and 82%).
Conclusion:
None of the four enzymatic tests accurately predicted the perfusion state of the infarct related coronary artery after thrombolysis. These tests cannot be used reliably in routine clinical practice as non-angiographic markers of coronary reperfusion.