Detection of coronary artery reperfusion with creatine kinase-MB determinations during thrombolytic therapy:
H D Garabedian1, H K Gold, T Yasuda
1Cardiac Division, Massachusetts General Hospital, Boston 02114.
Abstract:
Increases in plasma creatine kinase-MB (MB CK) were correlated with the onset of coronary artery reperfusion determined angiographically in 32 patients with acute myocardial infarction who were treated with recombinant human tissue-type plasminogen activator (rt-PA). Reperfusion occurred in 14 (70%) of 20 patients with left anterior descending coronary artery occlusion and in 8 (73%) of 11 patients with right coronary artery occlusion. One patient had persistent left circumflex coronary artery occlusion. Plasma MB CK levels (radioimmunometric assay) did not increase significantly in patients with persistent occlusion, but increased by a mean (+/- SEM) of 8 +/- 1 and 6 +/- 1 times over pretreatment levels at the end of the infusion in patients with a reperfused left anterior descending and right coronary artery, respectively. When a greater than or equal to 2.5-fold increase in MB CK levels at the end of the rt-PA infusion was taken as evidence of reperfusion of the left anterior descending coronary artery, 13 (93%) of 14 patients with reperfusion and 5 (83%) of 6 with persistent occlusion were correctly identified. When a greater than or equal to 2.2-fold increase in MB CK levels was used to identify right coronary artery reperfusion, seven (89%) of eight patients with persistent occlusion were correctly identified. The sensitivity and specificity of these indexes, derived from and applied to the same patient group, were 91 and 89%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Elevated creatine kinase-MB (CK-MB) levels indicate successful coronary artery reperfusion after acute myocardial infarction treatment with recombinant tissue-type plasminogen activator (rt-PA). This biomarker reliably identifies reperfusion in major coronary arteries.
Area of Science:
- Cardiology
- Biochemistry
- Medical Diagnostics
Background:
- Acute myocardial infarction (AMI) requires prompt restoration of blood flow to prevent cardiac damage.
- Recombinant human tissue-type plasminogen activator (rt-PA) is a key thrombolytic agent used in AMI treatment.
- Assessing the efficacy of reperfusion therapy is crucial for patient outcomes.
Purpose of the Study:
- To investigate the correlation between plasma creatine kinase-MB (CK-MB) levels and coronary artery reperfusion in AMI patients treated with rt-PA.
- To evaluate the diagnostic accuracy of CK-MB increases as an indicator of reperfusion in specific coronary arteries.
Main Methods:
- Prospective study of 32 AMI patients treated with rt-PA.
- Angiographic assessment of coronary artery reperfusion.
- Serial measurement of plasma CK-MB levels using a radioimmunometric assay.
- Statistical analysis to determine sensitivity and specificity of CK-MB thresholds for reperfusion.
Main Results:
- Reperfusion was achieved in 70% of left anterior descending (LAD) and 73% of right coronary artery (RCA) occlusions.
- Significant increases in plasma CK-MB levels were observed in patients with successful reperfusion.
- A ≥2.5-fold increase in CK-MB identified LAD reperfusion with 93% sensitivity and 83% specificity.
- A ≥2.2-fold increase in CK-MB identified RCA reperfusion with 89% sensitivity and 89% specificity.
Conclusions:
- Plasma CK-MB levels serve as a reliable biochemical marker for detecting coronary artery reperfusion following rt-PA therapy in AMI.
- Specific fold-increases in CK-MB can accurately predict reperfusion of LAD and RCA, aiding in treatment assessment.
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