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Creatine kinase (CK): its use in the evaluation of perioperative myocardial infarction
Insights
Diagnosing perioperative myocardial infarction requires more than just creatine kinase-MB (CK-MB) levels. Dual enzyme evaluation, including lactate dehydrogenase isoenzymes, improves diagnostic accuracy for acute myocardial infarction.
Area of Science:
- Cardiology
- Clinical Chemistry
- Biochemistry
Background:
- The diagnosis of acute perioperative myocardial infarction (MI) solely based on serum creatine kinase-MB (CK-MB) is unreliable.
- Various non-cardiac tissues contain CK-MB, and common laboratory methods for CK and isoenzyme measurement have limitations.
- Accurate CK-MB evaluation necessitates assessing the amplitude and temporal profile of elevation.
Purpose of the Study:
- To establish a more accurate diagnostic approach for acute perioperative myocardial infarction.
- To investigate the utility of dual enzyme evaluation for improving diagnostic sensitivity and specificity.
Main Methods:
- Analyzing the amplitude and temporal course of serum CK-MB elevation.
- Confirming CK-MB findings using an alternative enzyme system, specifically serum lactate dehydrogenase (LDH) isoenzymes.
- Implementing a dual enzyme evaluation strategy in clinical practice.
Main Results:
- Serum CK-MB band alone is insufficient for diagnosing perioperative MI.
- Dual enzyme evaluation using CK-MB and LDH isoenzymes significantly enhances diagnostic accuracy.
- This combined approach offers high sensitivity and specificity for detecting acute perioperative MI.
Conclusions:
- Accurate diagnosis of perioperative MI requires a comprehensive enzyme evaluation, not just CK-MB.
- Lactate dehydrogenase isoenzymes serve as a valuable confirmatory marker for CK-MB findings.
- Implementing dual enzyme testing is easily achievable and crucial for reliable MI diagnosis.
Abstract:
Establishing the diagnosis of acute perioperative myocardial infarction by the mere presence of a serum CK-MB band alone is not valid. Laboratory investigations have shown that tissues other than ventricular myocardium hold appreciable quantities of CK-MB. Moreover, each of the laboratory methods commonly used for measuring serum total CK and its isoenzymes have inherent strengths and weaknesses. Hence, accurate evaluation of perioperative CK-MB bands requires determination of the amplitude and the temporal course of the elevation. Confirmation of the CK-MB findings by analysis of another enzyme system is advisable. Serum lactate dehydrogenase isoenzymes can fulfill this role. Institution of a dual enzyme evaluation is achieved easily in most hospitals and can yield a very high degree of sensitivity and specificity. The final step in diagnostic accuracy is completed by continuing evaluation of the enzyme diagnostic system in each individual institution.