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Effects of nonsurgical myocardial reperfusion on plasma creatine kinase kinetics in man
Insights
Reperfusion significantly increases creatine kinase-MB (CK-MB) enzyme release rates in patients with acute myocardial infarction. This finding highlights the impact of reflow on cardiac enzyme release dynamics in humans.
Area of Science:
- Cardiology
- Biochemistry
Background:
- The release kinetics of creatine kinase-MB (CK-MB) post-myocardial reperfusion in humans remain under-investigated.
- Acute transmural myocardial infarction (AMI) presents challenges in understanding enzyme release patterns.
Purpose of the Study:
- To investigate the combined CK-MB time-activity curves following reflow to ischemic myocardium in humans.
- To compare CK-MB release rates between patients receiving conventional therapy and those undergoing successful reperfusion therapy.
Main Methods:
- Examined CK-MB time-activity curves in patients with AMI.
- Compared a conventional therapy group (CAMI, n=109) with a reperfusion therapy group (RAMI, n=9).
- Analyzed CK-MB levels at specific time points relative to reflow onset.
Main Results:
- Average reflow time in RAMI patients was 4.2 hours post-symptom onset.
- Time-to-peak CK-MB was significantly shorter in RAMI (9.9 hours) vs. CAMI (18.3 hours) patients (p < 0.001).
- At 6 hours post-reflow, RAMI patients showed significantly higher CK-MB levels (55 IU/L) compared to CAMI patients (20 IU/L) (p < 0.02).
Conclusions:
- Reflow to ischemic myocardium in humans significantly augments the release rate of CK-MB.
- Successful reperfusion therapy alters the enzymatic release profile following AMI.
- Understanding these altered release rates is crucial for managing myocardial infarction.
Abstract:
The rate and form of creatine kinase-MB (CK-MB) enzyme release following reflow to ischemic myocardium has not been specifically examined in man. In this investigation, we examined the combined CK-MB time-activity curves during acute transmural myocardial infarction (AMI) in a group of patients receiving conventional therapy (CAMI) (n = 109), and in a group of nine patients with successful reperfusion by fibrinolytic therapy (RAMI). The average time of reflow in the latter group was 4.2 +/- 1.7 hours (mean +/- SD) following the onset of symptoms. The average time-to-peak CK-MB for the CAMI group was 18.3 +/- 5.5 hours and for RAMI it was 9.9 +/- 1.1 p less than 0.001). At hour 4 (about the time of reflow), the two groups had similar CK-MB elevations (CAMI = 11 +/- 7, RAMI = 13 +/- 11 LU/L). By hour 6 (reflow + 2 hours), the RAMI CK-MB values were significantly higher (55 +/- 33 vs 20 +/- 15 IU/L, p less than 0.02) than the CAMI group, demonstrating an increase in the release rate of CK-MB associated with reperfusion. We conclude that in man, reflow to the ischemic myocardium significantly augments the release rate of CK-MB.