Circulation, Vol 75, 1162-1169, Copyright © 1987 by American Heart Association
PR Puleo, MB Perryman, MA Bresser, R Rokey, CM Pratt and R Roberts
Recent demonstrations of the efficacy of intravenous thrombolytic therapy
in acute myocardial infarction have emphasized the need for a noninvasive
index of successful reperfusion. The tissue form of MM creatine kinase
(MM3) is known to undergo posttranslational conversion to modified forms
MM2 and MM1 after release into the plasma following acute infarction. Since
this conversion is rapid, sustained elevation of plasma MM3 may be a marker
of the prolonged creatine kinase release characteristic of nonreperfused
infarction. Therefore, we investigated the rate of decline of plasma MM3 in
a consecutive series of patients undergoing thrombolytic therapy of acute
myocardial infarction, all of whom underwent acute angiography to assess
treatment success, as well as in 30 conventionally treated patients. Among
55 patients with angiographically documented successful reperfusion (group
IA), the rate of decline of MM3 was 4.18 +/- 1.25%/hr (mean +/- SD); in
contrast, the rate of decline was 2.37 +/- 1.11%/hr in 39 patients with
angiographically documented unsuccessful reperfusion (group IB) and 1.77
+/- 1.46%/hr among the 30 patients receiving conventional treatment (group
II) (p less than .001 for groups IB and II vs group IA). A cutoff value of
3.1%/hr minimized the overlap between the groups; 48/55 (87%) patients with
successful reperfusion had a rate of decline of MM3 of 3.1%/hr or more,
while 29 of 39 (74%) patients in whom thrombolysis was unsuccessful and 27
of 30 (90%) patients receiving conventional treatment had a rate of decline
less than 3.1%/hr (p less than .001 for groups IB and II vs group
IA).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Creatine kinase isoform analysis in the detection and assessment of thrombolysis in man
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