This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Puleo, P. R. Articles by Perryman, M. B. Search for Related Content PubMed PubMed Citation Articles by Puleo, P. R. Articles by Perryman, M. B.

Circulation, Vol 82, 759-764, Copyright © 1990 by American Heart Association

ARTICLES

Early diagnosis of acute myocardial infarction based on assay for subforms of creatine kinase-MB

PR Puleo, PA Guadagno, R Roberts, MV Scheel, AJ Marian, D Churchill and MB Perryman
Molecular Cardiology Unit, Baylor College of Medicine, Houston, Tex.

Thrombolytic therapy for patients with acute myocardial infarction (AMI) has produced the need for an accurate early diagnostic marker. We previously developed and assessed an assay for the creatine kinase (CK)- MB subforms; assay time is 25 minutes. Plasma MB2 (tissue subform) activity, MB1 (plasma-modified subform) activity, and MB2/MB1 ratio in 56 healthy individuals were 0.61 +/- 0.33 units/l, 0.63 +/- 0.33 units/l, and 0.94 +/- 0.39, respectively. Only one individual had both an MB2 activity greater than 1.0 units/l and an MB2/MB1 ratio of more than 1.5. Similar results were obtained in 50 hospitalized patients without cardiac disease; two of these patients had both an MB2 activity and an MB2/MB1 ratio greater than the cutoff values. Among 49 patients with AMI, MB2 activity and the MB2/MB1 ratio began to increase 2 hours after AMI; the ratio reached a plateau of 3.1 by 4-6 hours. The first available plasma sample was abnormal by the subform assay in 67% of patients and by a conventional MB assay in 27% of patients. Assay sensitivities in samples collected at 2-4, 4-6, and 6-8 hours after AMI were 59%, 92%, and 100% for the subform assay and 23%, 50%, and 71% for the conventional assay (p less than 0.03 versus subform assay at each time interval). False-negative results were obtained by the subform and conventional assays in 15 and 45 samples at a mean of 2.3 and 5.8 hours, respectively. Subform assay provides rapid and reliable diagnosis of AMI within 4-6 hours after the onset of symptoms, which is 6 hours before conventional CK-MB assays are accurate.

This article has been cited by other articles:

				N. S. Kleiman, N. Lakkis, C. P. Cannon, S. A. Murphy, P. M. DiBattiste, L. A. Demopoulos, W. S. Weintraub, E. Braunwald, and TACTICS-TIMI 18 Investigators Prospective analysis of creatine kinase muscle-brain fraction and comparison with troponin T to predict cardiac risk and benefit of an invasive strategy in patients with non-ST-elevation acute coronary syndromes J. Am. Coll. Cardiol., September 18, 2002; 40(6): 1044 - 1050. [Abstract] [Full Text] [PDF]

				H. Ay, E. M. Arsava, and O. Saribas Creatine Kinase-MB Elevation After Stroke Is Not Cardiac in Origin: Comparison With Troponin T Levels Stroke, January 1, 2002; 33(1): 286 - 289. [Abstract] [Full Text] [PDF]

				W. B. Gibler, J. W. Hoekstra, W. D. Weaver, M. W. Krucoff, A. P. Hallstrom, R. E. Jackson, M. R. Sayre, J. Christenson, G. L. Higgins, G. Innes, et al. A randomized trial of the effects of early cardiac serum marker availability on reperfusion therapy in patients with acute myocardial infarction: The serial markers, acute myocardial infarction and rapid treatment trial (SMARTT) J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1500 - 1506. [Abstract] [Full Text] [PDF]

				R. Edwards, T. Treasure, M. Hossein-Nia, A. Murday, G. H. Kantidakis, and D. W. Holt A controlled trial of substrate-enhanced, warm reperfusion (""hot shot"") versus simple reperfusion Ann. Thorac. Surg., February 1, 2000; 69(2): 551 - 555. [Abstract] [Full Text] [PDF]

				A. H.B. Wu, F. S. Apple, W. B. Gibler, R. L. Jesse, M. M. Warshaw, and R. Valdes Jr. National Academy of Clinical Biochemistry Standards of Laboratory Practice: Recommendations for the Use of Cardiac Markers in Coronary Artery Diseases Clin. Chem., July 1, 1999; 45(7): 1104 - 1121. [Abstract] [Full Text] [PDF]

				A. H. B. Wu, Y.-J. Feng, J. Nadelman, M. Acampora, and P. N. Fiedler Ectopic Production of Creatine Kinase MB: Updated Evaluation by Mass Assays Clin. Chem., October 1, 1997; 43(10): 2006 - 2007. [Full Text] [PDF]

				L. V. Lee, G. A. Ewald, C. R. McKenzie, and P. R. Eisenberg The Relationship of Soluble Fibrin and Cross-linked Fibrin Degradation Products to the Clinical Course of Myocardial Infarction Arterioscler. Thromb. Vasc. Biol., April 1, 1997; 17(4): 628 - 633. [Abstract] [Full Text]

				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]

				P. R. Puleo, D. Meyer, C. Wathen, C. B. Tawa, S. Wheeler, R. J. Hamburg, N. Ali, S. D. Obermueller, F. J. Triana, J. L. Zimmerman, et al. Use of a Rapid Assay of Subforms of Creatine Kinase MB to Diagnose or Rule Out Acute Myocardial Infarction N. Engl. J. Med., September 1, 1994; 331(9): 561 - 566. [Abstract] [Full Text]

				C. W. Hamm New Serum Markers for Acute Myocardial Infarction N. Engl. J. Med., September 1, 1994; 331(9): 607 - 608. [Full Text]