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  • Title: Estimation of infarct size by single measurements of creatine kinase levels in patients with a first myocardial infarction.
    Author: Di Chiara A, Plewka M, Werren M, Badano LP, Fresco C, Fioretti PM.
    Journal: J Cardiovasc Med (Hagerstown); 2006 May; 7(5):340-6. PubMed ID: 16645412.
    Abstract:
    OBJECTIVE: Enzymatic estimation of infarct size is desirable in the reperfusion era, because a possible discrepancy with the observed asynergic area of the left ventricle may suggest the presence of stunned myocardium. Unfortunately, timely myocardial reperfusion produces a rapid washout of creatine kinase (CK) in blood flow, which overestimates infarct size. In this perspective, we investigated whether the mid-terminal portion of the CK time-activity curve could predict infarct size more reliably. METHODS: Enzymatic infarct size was calculated by peak CK levels, the CK area under the curve and by single CK values, in 103 patients with a first ST-elevation myocardial infarction, and compared to the left ventricular akinetic area. The wall motion asynergy score at follow-up was considered as the actual infarct size. RESULTS: In patients with peak CK within 10 h of symptom onset, CK levels at 30 h showed a high independent correlation (r = 0.83; P < 0.001) with infarct size. In patients with late peak CK (> 10 h), CK levels at 12 h turned out to be the best predictor of infarct size (r = 0.55; P < 0.01). At multivariate regression analysis, peak CK was the best predictor of infarct size in the whole population (r = 0.61; P < 0.001). CONCLUSIONS: In patients with ST-elevation myocardial infarction and early peak CK, infarct size at follow-up could be better estimated with single values of the mid-terminal portion of the CK time-activity curve.
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