[Myocardial creatinine kinase liberation and left ventricular function in myocardial infarct with and without...

In 24 patients (aged 52 years) with angiographically proven acute first myocardial infarction and isolated occlusion of the infarct-related vessel, serial measurements of creatine kinase (CK) activity were performed. Peak CK levels (CKmax), time-to-peak activity (tmax), infarct size, and cumulative CK were calculated from the serum curve by a computer program. No reperfusion interventions were performed. In accordance with the angiographic results 3-5 weeks after infarction, patients were divided into two groups: 11 patients demonstrated a proximal occlusion of one major coronary artery with retrograde contrast filling by non-compromised collaterals; in 14 patients no collateral filling of the distal vessel segment was visible. The contralateral coronary arteries and corresponding LV wall segments were normal. Localization of the infarction and infarct related vessel were not significantly different between both groups. In patients with collaterals, ejection fraction was significantly higher (63.1 vs. 45.5%; p less than 0.0005) and LV-enddiastolic volume (109.9 vs. 130.1 ml/m2) and enddiastolic pressure (10.0 vs. 14.1 mm Hg, p = n.s.) were lower. CKmax, tmax, infarct size, and cumulative CK activity were significantly reduced in patients with collaterals compared to non-collateralized occlusions. Four patients with, but none without collaterals reached tmax within 12 h. In ten patients without and four with collaterals, tmax was reached after 14 h. The initial slope of the normalized serum CK curves was significantly different among both groups. A significant (p less than 0.005) linear correlation between ejection fraction and tmax, infarct size, CKmax, and cumulative CK was found for all patients (r = 0.76-0.53).(ABSTRACT TRUNCATED AT 250 WORDS)