A physiologically based model of creatine kinase-MB release in reperfusion of acute myocardial infarction.
To gain insight into the altered kinetics of creatine kinase-MB (CK-MB) release after reperfusion, a physiologically based model with first-order CK-MB appearance and disappearance functions was postulated. This biexponential model is based on the assumption that reperfusion reestablishes nutritive blood flow, providing direct access of interstitial CK-MB to the bloodstream. This is in contrast to persistent coronary artery occlusion, in which no direct access to nutritive flow is present. The accuracy of this model was examined in 8 dogs reperfused after 2 hours of coronary artery occlusion. The fit to observed values was excellent, with a mean r2 of 0.97 +/- 0.05. In agreement with the biexponential model, the initial increase in CK-MB activity was abrupt and rapid. The same degree of accuracy was found in 21 patients with angiographic evidence of reperfusion after thrombolytic therapy (mean r2 0.97 +/- 0.02). The appearance characteristics were similar to the animal model, with an abrupt and rapid increase in CK-MB activity. When compared with 5 patients with persistent occlusion, ka, the rate constant of the appearance function, clearly distinguished patients with reperfusion (chi-square = 20.6, p less than 0.0001), whereas considerable overlap was present in the time to peak CK-MB (time to peak less than 12 hours, chi-square = 3.6, difference not significant). Alterations of CK-MB release in reperfusion can be accurately modeled with the biexponential model. The characteristics of this model suggest that early identification of reperfusion by serial CK-MB assay is possible.
Ong
L
L
Department of Medicine, North Shore University Hospital, Manhasset, New York 11030.
Coromilas
J
J
Zimmerman
J M
JM
Green
S
S
Padmanabhan
V
V
Reiser
P
P
Bigger
J T
JT
Morrison
J
J
D000818:Animals; D003402:Creatine Kinase / Q000378:metabolism*; D004285:Dogs; D006801:Humans; D007527:Isoenzymes; D008954:Models, Biological; D009203:Myocardial Infarction / Q000201:enzymology / Q000628:therapy*; D015425:Myocardial Reperfusion
D007527:Isoenzymes; D003402:Creatine Kinase