Early Diagnosis of Myocardial Infarction by Timed Sequential Enzyme Measurements

Abstract

Serum samples from patients admitted to a coronary care unit with a history of acute chest pain suggestive of myocardial infarction in the previous 12 h were obtained on admission and at 6 and 12 h, thereafter. Creatine kinase (CK), CK-MB isoenzyme, CK-MM sub-bands, myoglobin, and lactate dehydrogenase (LD) isoenzymes were examined. Changes were evaluated in relation to the diagnosis obtained from clinical examination, serial electrocardiography and ‘routine’ cardiac enzymes (CK, aspartate transaminase and alpha-hydroxy butyrate dehydrogenase daily for 3 days following admission). The slope of the logarithms of CK, CK-MB activity and CK-MB concentration in the early post infarct period fully distinguished between infarct and non-infarct patients. Measurement of myoglobin and lactate dehydrogenase isoenzymes was less sensitive. Serial estimation of CK-MM sub-band patterns allowed the time from infarction to be estimated. Serial estimation of CK in the 12 h following admission can be substituted for conventional daily enzyme estimations for the diagnosis of acute myocardial infarction in patients with onset of chest pain within the previous 12 h. This could reduce laboratory and in-patient costs.

Cardiac Biomarkers for Detection of Myocardial Infarction: Perspectives from Past to Present

“…It invariably shows a rapid increase in serum in the early hours after admission with chest pain from infarction (6 ). In addition, monitoring of increases in serum creatine kinase remains the most sensitive diagnostic enzyme procedure for the detection of myopathy, for the preclinical detection of muscular dystrophy and for detection of dystrophy carriers, and for the assessment of response of polymyositis to therapy.…”

“…The enzyme responsible for catalyzing the transfer of highenergy phosphate from creatine phosphate to ATP is creatine kinase (CK). 6 It is perhaps somewhat surprising that this molecule would take center stage in the diagnosis of myocardial infarction. However, the heart, a muscle that continually contracts without a break, has a high energy requirement.…”

Triage of acute onset chest pain: now a biochemical rule-out test?

“…7 However if the diagnosis of ACS is missed, prognosis may be significantly worsened with evidence of a two-to three-fold increase in short term mortality. [8][9][10][11][12] The measurement of biomarkers, in particular troponin, has revolutionised ACS assessment.…”

“…The challenge for the laboratory has been to deliver a rapid biomarkerbased confirmation or exclusion of significant myocardial injury. Although strategies based on rapid serial measurement of conventional cardiac enzymes such as creatine kinase (CK) 10 and its MB isoenzyme 11 can significantly reduce time to confirmation or exclusion of AMI, 12 neither of these tests are cardiac specific. The ability to measure the protein components of the cardiac contractile apparatus, the cardiac troponins cardiac troponin T (cTnT) 13 and cardiac troponin I (cTnI) 14 represented a significant breakthrough in the field of cardiac biomarker measurement.…”

A Rapid Assay for the Quantification of Myoglobin: Evaluation and Diagnostic Relevance in the Diagnosis of Acute Myocardial Infarction

“…If the first blood sample from patients with acute myocardial infarction is taken later than 4 hours after onset of ehest pain, myoglobin can lead to false negative diagnosis. For this reason, the simultaneous determination of creatine kinase and its isoenzyme creatine kinase-MB is still the diagnostic strategy of choice for the diagnosis of acute myocardial infarction (4). On the other hand, in monitoring thrombolysis therapy of acute myocardial infarction, the determination of myoglobin in superior to creatine kinase.…”