Automated creatine kinase-MB estimation by immuno-inhibition: a clinical evaluation

We detected the presence of creatine kinase (EC 2.7.3.2) MB isoenzyme (CK-MB) in serum by using an immunoinhibition technique to inactivate the creatine kinase isoenzyme of muscle origin (CK-MM). The GEMSAEC centrifugal analyzer is ideally suited for this procedure because it rapidly mixes reagents and has a throughput of 60 samples/h. The within-run CV was acceptable when the CK-MB value was 7.5 U/L or more. CK-MM was totally inactivated up to 5000 U/L, a value well above that usually seen in myocardial-infarct patients. We assessed the predictability of the assay for detecting myocardial infarction among 120 coronary-care patients when 2% of total CK activity was considered diagnostic and compared the results with those obtained with an electrophoresis technique. The positive predictive value of the immunoinhibition assay was 97.8%, as compared to 92% with the CK electrophoresis technique, when lactate dehydrogenase (EC 1.1.1.27) isoenzyme results were included in both cases. The optimal negative predictive value was 95.1% with the immunoinhibition assay vs 98.2% with electrophoresis. We conclude that the immunoinhibition technique for estimating CK-MB can be automated to assess myocardial status rapidly, precisely, inexpensively, and sensitively.