Skip to main content
PMC home page
British Heart Journal logoLink to British Heart Journal
. 1992 Feb;67(2):150–154. doi: 10.1136/hrt.67.2.150

Are enzymatic tests good indicators of coronary reperfusion?

H A Bosker 1, A van der Laarse 1, V M Cats 1, A V Bruschke 1
PMCID: PMC1024745  PMID: 1540435

Abstract

OBJECTIVE--To assess the accuracy of four enzymatic tests, including early release rates of creatine kinase and alpha-hydroxybutyrate dehydrogenase, in assessing coronary reperfusion after thrombolytic therapy. DESIGN--A prospective clinical trial identifying patients with a successful thrombolytic treatment. PATIENTS--Eighty nine patients with acute myocardial infarction were studied. Arteriography showed a closed infarct related artery in all of them. Reperfusion due to thrombolysis occurred in 74 patients and there was no reperfusion in 15 patients. RESULTS--The 74 patients showing coronary reperfusion had a significantly shorter time to peak creatine kinase activity, higher early release rates for creatine kinase and alpha-hydroxybutyrate dehydrogenase, and a more rapid release of alpha-hydroxybutyrate dehydrogenase (ratio of cumulative release of alpha-hydroxybutyrate dehydrogenase during the first 24 hours to that 72 hours after infarction). All these differences were statistically significant (p less than 0.001). Optimum cut off levels were determined with decision level plots and the accuracy of the four enzymatic tests was calculated. Accuracy was low for all four tests (73%, 70%, 70%, and 82%). CONCLUSION--None of the four enzymatic tests accurately predicted the perfusion state of the infarct related coronary artery after thrombolysis. These tests cannot be used reliably in routine clinical practice as non-angiographic markers of coronary reperfusion.

Full text

PDF
150

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abendschein D. R. Rapid diagnosis of myocardial infarction and reperfusion by assay of plasma isoforms of creatine kinase isoenzymes. Clin Biochem. 1990 Oct;23(5):399–407. doi: 10.1016/0009-9120(90)90136-i. [DOI] [PubMed] [Google Scholar]
  2. Beck J. R., Shultz E. K. The use of relative operating characteristic (ROC) curves in test performance evaluation. Arch Pathol Lab Med. 1986 Jan;110(1):13–20. [PubMed] [Google Scholar]
  3. Blanke H., von Hardenberg D., Cohen M., Kaiser H., Karsch K. R., Holt J., Smith H., Jr, Rentrop P. Patterns of creatine kinase release during acute myocardial infarction after nonsurgical reperfusion: comparison with conventional treatment and correlation with infarct size. J Am Coll Cardiol. 1984 Mar;3(3):675–680. doi: 10.1016/s0735-1097(84)80242-9. [DOI] [PubMed] [Google Scholar]
  4. Califf R. M., O'Neil W., Stack R. S., Aronson L., Mark D. B., Mantell S., George B. S., Candela R. J., Kereiakes D. J., Abbottsmith C. Failure of simple clinical measurements to predict perfusion status after intravenous thrombolysis. Ann Intern Med. 1988 May;108(5):658–662. doi: 10.7326/0003-4819-108-5-658. [DOI] [PubMed] [Google Scholar]
  5. Califf R. M., Topol E. J., George B. S., Boswick J. M., Lee K. L., Stump D., Dillon J., Abbottsmith C., Candela R. J., Kereiakes D. J. Characteristics and outcome of patients in whom reperfusion with intravenous tissue-type plasminogen activator fails: results of the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) I trial. Circulation. 1988 May;77(5):1090–1099. doi: 10.1161/01.cir.77.5.1090. [DOI] [PubMed] [Google Scholar]
  6. Cercek B., Lew A. S., Laramee P., Shah P. K., Peter T. C., Ganz W. Time course and characteristics of ventricular arrhythmias after reperfusion in acute myocardial infarction. Am J Cardiol. 1987 Aug 1;60(4):214–218. doi: 10.1016/0002-9149(87)90216-5. [DOI] [PubMed] [Google Scholar]
  7. Fung A. Y., Lai P., Topol E. J., Bates E. R., Bourdillon P. D., Walton J. A., Mancini G. B., Kryski T., Pitt B., O'Neill W. W. Value of percutaneous transluminal coronary angioplasty after unsuccessful intravenous streptokinase therapy in acute myocardial infarction. Am J Cardiol. 1986 Oct 1;58(9):686–691. doi: 10.1016/0002-9149(86)90338-3. [DOI] [PubMed] [Google Scholar]
  8. Ganz W., Geft I., Maddahi J., Berman D., Charuzi Y., Shah P. K., Swan H. J. Nonsurgical reperfusion in evolving myocardial infarction. J Am Coll Cardiol. 1983 May;1(5):1247–1253. doi: 10.1016/s0735-1097(83)80136-3. [DOI] [PubMed] [Google Scholar]
  9. Garabedian H. D., Gold H. K., Yasuda T., Johns J. A., Finkelstein D. M., Gaivin R. J., Cobbaert C., Leinbach R. C., Collen D. Detection of coronary artery reperfusion with creatine kinase-MB determinations during thrombolytic therapy: correlation with acute angiography. J Am Coll Cardiol. 1988 Apr;11(4):729–734. doi: 10.1016/0735-1097(88)90204-5. [DOI] [PubMed] [Google Scholar]
  10. Goldberg S., Greenspon A. J., Urban P. L., Muza B., Berger B., Walinsky P., Maroko P. R. Reperfusion arrhythmia: a marker of restoration of antegrade flow during intracoronary thrombolysis for acute myocardial infarction. Am Heart J. 1983 Jan;105(1):26–32. doi: 10.1016/0002-8703(83)90274-0. [DOI] [PubMed] [Google Scholar]
  11. Gore J. M., Roberts R., Ball S. P., Montero A., Goldberg R. J., Dalen J. E. Peak creatine kinase as a measure of effectiveness of thrombolytic therapy in acute myocardial infarction. Am J Cardiol. 1987 Jun 1;59(15):1234–1238. doi: 10.1016/0002-9149(87)90896-4. [DOI] [PubMed] [Google Scholar]
  12. Hackworthy R. A., Vogel M. B., Harris P. J. Relationship between changes in ST segment elevation and patency of the infarct-related coronary artery in acute myocardial infarction. Am Heart J. 1986 Aug;112(2):279–284. doi: 10.1016/0002-8703(86)90262-0. [DOI] [PubMed] [Google Scholar]
  13. Kircher B. J., Topol E. J., O'Neill W. W., Pitt B. Prediction of infarct coronary artery recanalization after intravenous thrombolytic therapy. Am J Cardiol. 1987 Mar 1;59(6):513–515. doi: 10.1016/0002-9149(87)91158-1. [DOI] [PubMed] [Google Scholar]
  14. Krouwer J. S. Cumulative distribution analysis graphs--an alternative to ROC curves. Clin Chem. 1987 Dec;33(12):2305–2306. [PubMed] [Google Scholar]
  15. Krucoff M. W., Green C. E., Satler L. F., Miller F. C., Pallas R. S., Kent K. M., Del Negro A. A., Pearle D. L., Fletcher R. D., Rackley C. E. Noninvasive detection of coronary artery patency using continuous ST-segment monitoring. Am J Cardiol. 1986 Apr 15;57(11):916–922. doi: 10.1016/0002-9149(86)90730-7. [DOI] [PubMed] [Google Scholar]
  16. Lee G., Amsterdam E. A., Low R., Joye J. A., Kimchi A., DeMaria A. N., Mason D. T. Efficacy of percutaneous transluminal coronary recanalization utilizing streptokinase thrombolysis in patients with acute myocardial infarction. Am Heart J. 1981 Dec;102(6 Pt 2):1159–1167. doi: 10.1016/0002-8703(81)90647-5. [DOI] [PubMed] [Google Scholar]
  17. Lewis B. S., Ganz W., Laramee P., Cercek B., Hod H., Shah P. K., Lew A. S. Usefulness of a rapid initial increase in plasma creatine kinase activity as a marker of reperfusion during thrombolytic therapy for acute myocardial infarction. Am J Cardiol. 1988 Jul 1;62(1):20–24. doi: 10.1016/0002-9149(88)91358-6. [DOI] [PubMed] [Google Scholar]
  18. Nohara R., Myears D. W., Sobel B. E., Abendschein D. R. Optimal criteria for rapid detection of myocardial reperfusion by creatine kinase MM isoforms in the presence of residual high grade coronary stenosis. J Am Coll Cardiol. 1989 Oct;14(4):1067–1073. doi: 10.1016/0735-1097(89)90491-9. [DOI] [PubMed] [Google Scholar]
  19. Ong L., Coromilas J., Zimmerman J. M., Green S., Padmanabhan V., Reiser P., Bigger J. T., Jr, Morrison J. A physiologically based model of creatine kinase-MB release in reperfusion of acute myocardial infarction. Am J Cardiol. 1989 Jul 1;64(1):11–15. doi: 10.1016/0002-9149(89)90645-0. [DOI] [PubMed] [Google Scholar]
  20. Reimer K. A., Lowe J. E., Rasmussen M. M., Jennings R. B. The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs duration of coronary occlusion in dogs. Circulation. 1977 Nov;56(5):786–794. doi: 10.1161/01.cir.56.5.786. [DOI] [PubMed] [Google Scholar]
  21. Rentrop P., Blanke H., Karsch K. R., Kaiser H., Köstering H., Leitz K. Selective intracoronary thrombolysis in acute myocardial infarction and unstable angina pectoris. Circulation. 1981 Feb;63(2):307–317. doi: 10.1161/01.cir.63.2.307. [DOI] [PubMed] [Google Scholar]
  22. Shell W., Mickle D. K., Swan H. J. Effects of nonsurgical myocardial reperfusion on plasma creatine kinase kinetics in man. Am Heart J. 1983 Oct;106(4 Pt 1):665–669. doi: 10.1016/0002-8703(83)90084-4. [DOI] [PubMed] [Google Scholar]
  23. Sobel B. E., Bergmann S. R. Coronary thrombolysis: some unresolved issues. Am J Med. 1982 Jan;72(1):1–4. doi: 10.1016/0002-9343(82)90563-0. [DOI] [PubMed] [Google Scholar]
  24. Ward C. D. The differential positive rate, a derivative of receiver operating characteristic curves useful in comparing tests and determining decision levels. Clin Chem. 1986 Jul;32(7):1428–1429. [PubMed] [Google Scholar]
  25. Werns S. W., Shea M. J., Lucchesi B. R. Free radicals and myocardial injury: pharmacologic implications. Circulation. 1986 Jul;74(1):1–5. doi: 10.1161/01.cir.74.1.1. [DOI] [PubMed] [Google Scholar]
  26. van der Laarse A., Hermens W. T., Hollaar L., Jol M., Willems G. M., Lemmers H. E., Liem A. H., Souverijn J. H., Oudhof J. H., de Hooge J. Assessment of myocardial damage in patients with acute myocardial infarction by serial measurement of serum alpha-hydroxybutyrate dehydrogenase levels. Am Heart J. 1984 Feb;107(2):248–260. doi: 10.1016/0002-8703(84)90372-7. [DOI] [PubMed] [Google Scholar]
  27. van der Laarse A., Vermeer F., Hermens W. T., Willems G. M., de Neef K., Simoons M. L., Serruys P. W., Res J., Verheugt F. W., Krauss X. H. Effects of early intracoronary streptokinase on infarct size estimated from cumulative enzyme release and on enzyme release rate: a randomized trial of 533 patients with acute myocardial infarction. Am Heart J. 1986 Oct;112(4):672–681. doi: 10.1016/0002-8703(86)90460-6. [DOI] [PubMed] [Google Scholar]
  28. van der Laarse A., van der Wall E. E., van den Pol R. C., Vermeer F., Verheugt F. W., Krauss X. H., Bär F. W., Hermens W. T., Willems G. M., Simoons M. L. Rapid enzyme release from acutely infarcted myocardium after early thrombolytic therapy: washout or reperfusion damage? Am Heart J. 1988 Apr;115(4):711–716. doi: 10.1016/0002-8703(88)90869-1. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES