Optimal criteria for rapid detection of myocardial reperfusion by creatine kinase MM isoforms in the presence of residual high grade coronary stenosis
R Nohara,
DW Myears,
BE Sobel,
and
DR Abendschein
Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri.
Analysis of isoforms of MM creatine kinase (CK) in plasma is being developed as a means for rapid detection of coronary recanalization in patients given thrombolytic agents. To determine whether flow-limiting residual stenosis typical of that seen in patients affects plasma isoform profiles, stenosis sufficient to preclude reactive hyperemia was induced in dogs before coronary occlusion, followed by recanalization in 2 h. Plasma activities of the MM CK isoform released from myocardium (MM3) and its two conversion products elaborated sequentially (MM2 and MM1) were assayed in serial samples with a rapid quantitative chromatofocusing procedure. Reperfusion in 10 dogs shortened the mean intervals (+/-SD) to the occurrence of peak MM3 activity (3.7 +/- 0.9 h), peak MM3 expressed as a percent of total CK activity (MM3%, 2.5 +/- 0.3 h) and the maximal ratio of MM3 to MM1 (2.7 +/- 0.3 h) compared with results in 10 control dogs without reperfusion. Nevertheless, the appearance of these peaks was delayed by 8% to 57% when residual stenosis was present. In contrast, the rate of increase of MM3% was delineated before the peak, was fivefold greater with recanalization (1.19 +/- 0.46 versus 0.26 +/- 0.11% min-1 in control dogs) and was not attenuated by residual stenosis. Thus, this criterion appears capable of delineating recanalization early after thrombolysis whether or not high grade residual stenosis is present.
