Detection of coronary artery reperfusion with creatine kinase-MB determinations during thrombolytic therapy: Correlation with acute angiography

AbstractIncreases in plasma creating kinase-MB (MB CK) were correlated with the onset of coronary artery reperfusion determined angiographically in 32 patients with acute myocardial infarction who were treated with, recombinan' human tissue-type plasminogen activator (rt-PA). Reperfusion occurred in 14 (70%) of 20 patients with left anterior descending coronary artery occlusion and in 8 (73%) of 11 patients with right coronary artery occlusion. One patient had persistent left circumflex coronary artery occlusion. Plasma MB CK levels (radioimmunometric assay) did not increase significantly in patients with persistent occlusion, but increased by a mean (± SEM) of 8 ± 1 and 6 ± 1 times over pretreatment levels at the end of the infusion in patients with a reperfused left anterior descending and right coronary artery, respectively. When a ≥2.5-fold increase in MB CK levels at the end of the rt-PA infusion was taken as evidence of reperfusion of the left anterior descending coronary artery, 13 (93%) or 14 patients with reperfusion and 5 (83%) of 6 with persistent occlusion were correctly identified. When a ≥2.2-fold increase in MB CK levels was used to identify right coronary artery reperfusion, seven (89%) of eight patients with reperfusion and three (100%) of three patients with persistent occlusion were correctly identified. The sensitivity and specificity of these indexes, derived from and applied to the same patient group, were 91 and 89%, respectively.These indexes were then applied prospectively to 16 patients wth anterior, 16 with inferior and 5 vilh inferoposterier infarction in whom MB CK was assayed hoth before and at completion of a 90 min rt-PA infusion and coronary angiography performed at 90 min. Of 13 patients with anterior infarction and a patent left anterior descending coronary artery, 12 (92%) demonstrated a ≥2.5-fold increase in MB CK, whereas all 3 patients with a persistently occluded artery had a smaller increase. Of 13 patients with inferior infarction and a patent right coronary artery, 10 (77%) had a ≥2.2-fold increase in MB CK, whereas the 3 patients with persistent occlusion had a <2.2-fold increase (sensitivity 85%, specificity 100% 1. Of the five patiencs with inferoposterior infarction, three showed a patent left circumflex coronary artery and a ≥2.5-fald increase in MB CK, whereas two patients with persistent occlusion had a <2-fold increase.Reanalysis of MB CK levels was performed with a rapid end point, immunofunctional assay (