1 From the Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California.
Infarct size was assessed quantitatively in 33 patients with acute myocardial infarction with a new technic based on analysis of serial serum creatine phosphokinase (CPK) changes to determine its relationship to prognosis. We have recently measured infarct size in the conscious dog with this method which takes into account CPK distribution space, fractional disappearance rate, proportion degraded in myocardium, and proportion released into the circulation, and we have validated the method by measurement of myocardial CPK depletion in the same animals. In the present study, CPK activity (determined spectrophotometrically) and isoenzyme profiles (assayed electrophoretically) were measured in patient serum samples obtained every 2 hours. Infarct size was estimated by mathematical analysis of serial CPK changes utilizing the method previously developed in the conscious dog model. CPK isoenzyme profiles demonstrated prominent anodal bands, absent from normal serum, indicating that enzyme elevations reflected CPK released from heart rather than skeletal muscle. In 19 class I-II survivors (New York Heart Association) estimated infarct size was 31 ± 4 CPK-gram-equivalents (CPK-g-Eq). It was significantly larger (P < 0.01), 103 ± 14, in nine patients who died and in four class III or IV survivors (91 ± 8). Estimation of cumulative infarct size differentiated patients with electrocardiographic changes and clinical sequelae from complications such as pericarditis from those patients with extension of infarction. Thus, infarct size can be assessed quantitatively in patients with acute myocardial infarction and provide a useful diagnostic and prognostic index based on the extent of myocardial damage.
Submitted on January 4, 1972
© 1972 American Heart Association, Inc.
Estimation of Infarct Size in Man and its Relation to Prognosis
Key Words: Ischemic injury • Myocardial CPK • Myocardial necrosis • CPK isoenzymes • Cell death • Serum CPK • Serum enzymes • Power failure
Accepted on April 28, 1972
This article has been cited by other articles:
 |
|
 |
|
  NACB WRITING GROUP MEMBERS, D. A. Morrow, C. P. Cannon, R. L. Jesse, L. K. Newby, J. Ravkilde, A. B. Storrow, A. H.B. Wu, and R. H. Christenson National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes Circulation, April 3, 2007; 115(13): e356 - e375. [Full Text] [PDF]
|
|
|
|
 |
|
 NACB WRITING GROUP MEMBERS, D. A. Morrow, C. P. Cannon, R. L. Jesse, L. K. Newby, J. Ravkilde, A. B. Storrow, A. H.B. Wu, R. H. Christenson, NACB COMMITTEE MEMBERS, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes Clin. Chem., April 1, 2007; 53(4): 552 - 574. [Full Text] [PDF]
|
|
|
|
 |
|
 S. F. De Marchi, P. Meier, P. Oswald, and C. Seiler Variable ECG signs of ischemia during controlled occlusion of the left and right coronary artery in humans Am J Physiol Heart Circ Physiol, July 1, 2006; 291(1): H351 - H356. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Halkin, G. W. Stone, C. L. Grines, D. A. Cox, B. D. Rutherford, P. Esente, C. M. Meils, P. Albertsson, A. Farah, J. E. Tcheng, et al. Prognostic Implications of Creatine Kinase Elevation After Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction J. Am. Coll. Cardiol., March 7, 2006; 47(5): 951 - 961. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gibbons, U. S. Valeti, P. A. Araoz, and A. S. Jaffe The quantification of infarct size J. Am. Coll. Cardiol., October 19, 2004; 44(8): 1533 - 1542. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. W. Mahaffey, C. B. Granger, J. C. Nicolau, W. Ruzyllo, W. D. Weaver, P. Theroux, J. S. Hochman, T. G. Filloon, C. F. Mojcik, T. G. Todaro, et al. Effect of Pexelizumab, an Anti-C5 Complement Antibody, as Adjunctive Therapy to Fibrinolysis in Acute Myocardial Infarction: The COMPlement inhibition in myocardial infarction treated with thromboLYtics (COMPLY) Trial Circulation, September 9, 2003; 108(10): 1176 - 1183. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Panteghini, C. Cuccia, G. Bonetti, R. Giubbini, F. Pagani, and E. Bonini Single-Point Cardiac Troponin T at Coronary Care Unit Discharge after Myocardial Infarction Correlates with Infarct Size and Ejection Fraction Clin. Chem., September 1, 2002; 48(9): 1432 - 1436. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Savonitto, C. B. Granger, D. Ardissino, L. Gardner, C. Cavallini, M. Galvani, F. Ottani, H. D. White, P. W. Armstrong, E. M. Ohman, et al. The prognostic value of creatine kinase elevations extends across the whole spectrum of acute coronary syndromes J. Am. Coll. Cardiol., January 2, 2002; 39(1): 22 - 29. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Wolf, L. Gepstein, U. Dror, G. Hayam, R. Shofti, A. Zaretzky, G. Uretzky, U. Oron, and S. A. Ben-Haim Detailed endocardial mapping accurately predicts the transmural extent of myocardial infarction J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1590 - 1597. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. Roe, E. M. Ohman, A. C. P. Maas, R. H. Christenson, K. W. Mahaffey, C. B. Granger, R. A. Harrington, R. M. Califf, and M. W. Krucoff Shifting the open-artery hypothesis downstream: the quest for optimal reperfusion J. Am. Coll. Cardiol., January 1, 2001; 37(1): 9 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Alexander, R. A. Sparapani, K. W. Mahaffey, J. W. Deckers, L. K. Newby, E. M. Ohman, R. Corbalan, S. L. Chierchia, J. B. Boland, M. L. Simoons, et al. Association Between Minor Elevations of Creatine Kinase-MB Level and Mortality in Patients With Acute Coronary Syndromes Without ST-Segment Elevation JAMA, January 19, 2000; 283(3): 347 - 353. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. A. Brown, G. V. Heller, R. S. Landin, L. J. Shaw, G. A. Beller, M. J. Pasquale, and S. B. Haber Early Dipyridamole 99mTc-Sestamibi Single Photon Emission Computed Tomographic Imaging 2 to 4 Days After Acute Myocardial Infarction Predicts In-Hospital and Postdischarge Cardiac Events : Comparison With Submaximal Exercise Imaging Circulation, November 16, 1999; 100(20): 2060 - 2066. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. van der Laarse Rapid estimation of myocardial infarct size Cardiovasc Res, November 1, 1999; 44(2): 247 - 248. [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Scheuer and S. W. Mifflin Repeated intermittent stress exacerbates myocardial ischemia-reperfusion injury Am J Physiol Regulatory Integrative Comp Physiol, February 1, 1998; 274(2): R470 - R475. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Kellett and J. Clarke Comparison of "Accelerated" Tissue Plasminogen Activator with Streptokinase for Treatment of Suspected Myocardial Infarction Med Decis Making, October 1, 1995; 15(4): 297 - 310. [Abstract] [PDF]
|
|
|
|
 |
|
 H. Silber, M. J. Hausmann, A. Katz, H. Gilutz, N. Zucker, and I. Ovsyshcher Short- and Long-Term Comparative Study of Anistreplase Versus Streptokinase in Acute Myocardial Infarction Angiology, July 1, 1992; 43(7): 572 - 577. [Abstract] [PDF]
|
|
|
|
|
|
I. Ovsyshcher, H. Silber, M.I. Hausman, G. Margolis, and M. Gueron Improved Left Ventricular Function in Myocardial Infarction Following Intravenous Thrombolytic Therapy with Acylated Plasminogen Activator Angiology, February 1, 1990; 41(2): 133 - 138. [Abstract] [PDF]
|
|
|
|
|
|
D. C. Babalis, G. N. Boutos, E. K. Iliodromitis, A. K. Trovas, and E. M. Vorides Precordial ECG Mapping in Acute Myocardial Infarction (AMI) After Intravenous Infusion of Streptokinase (s) Angiology, December 1, 1989; 40(12): 1040 - 1047. [Abstract] [PDF]
|
|
|
|
 |
|
 E. J. Harris JR and J. M. Porter Thrombolytic Therapy and Modern Vascular Surgery: An Overview Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 1989; 2(2): 40 - 63. [PDF]
|
|
|
|
 |
|
 J. Hirsh and J. A. Cairns Analytic Reviews : Antithrombotic Tberapy in Acute Myocardial Infarction and Unstable Angina J Intensive Care Med, November 1, 1987; 2(6): 299 - 312. [PDF]
|
|
|
|
|
|
R. B. Whiting Lactic Dehydrogenase and Fraction 1 in Acute Myocardial Infarction Angiology, November 1, 1981; 32(11): 764 - 772. [PDF]
|
|
|
|
 |
|
 D. Glogar, R. Kloner, J Muller, L. DeBoer, E Braunwald, and L. Clark Jr Fluorocarbons reduce myocardial ischemic damage after coronary occlusion Science, March 27, 1981; 211(4489): 1439 - 1441. [Abstract] [PDF]
|
|
|
|
|
|
F. A. Cecena-Seldner and J. Villarreal Effect of the Kallikrein Inhibitor Aprotinin on Myocardial Ischemia and Necrosis in Man Angiology, July 1, 1980; 31(7): 488 - 496. [Abstract] [PDF]
|
|