Creatine kinase isoform electrophoresis for the early confirmation of myocardial infarction detected by timed sequential CK slope analysis

Abstract

Summary:Creatine kinase (CK)-MM and -MB isoforms were evaluated for the early diagnosis of myocardial infarction in patients aged over 65 years admitted to a district general hospital with acute chest pain.Samples were collected for standard cardiac enzymes, timed CK slope analysis, and CKMM and CKMB isoform analysis from 48 patients admitted with acute chest pain. CKMM and CKMB isoform analyses were conducted using a Helena Rep electrophoresis system under standard conditions supplied by the company. In addition to the results of the biochemical tests the discharge diagnosis ofthe patients were also recorded.CKMM isoform analysis resulted in three false-negative classifications of patients and one false-positive. The predictive value of this test was 100% for a positive result and 94% for a negative result. CKMB isoform analysis was less accurate and there were six false-negative results and five false-positive results. The predictive value of a positive result was 75% and 85% for a negative result. CK isoform analysis became unreliable when mean total CK levels in serum were 210 IU/I (± 171).CK isoform analysis may be of use in the investigation of patients whose samples have a total CK concentration greater than the reference range but was no better than timed CK slope analysis for the detection of myocardial infarction in patients aged more than 65 years.

Myocardial Markers of Injury:Evolution and Insights

“…64,65 This is substantially equivalent to the principle advocated by Lee. 66 Nevertheless, a contrary evaluation of the contribution of slope measurement has been noted, 67,68 probably attributable to the author's use of electrophoresis and immunoinhibition assays.…”

“…Advocates of monitoring total CK,' 63 myoglobin, 164 -' 65 and cTnT' 66 among others have recently reported successful applications. In a useful and informative review, the biochemical markers have been compared to continuous ECG monitoring.…”