title: Rate of disappearance of creatine kinase-MB after acute myocardial infarction: clinical determinants of variability.
abstract: The apparent rate of disappearance (Kd) of creatine kinase (CK)-MB is used in the calculation of the size of acute myocardial infarction (AMI), but little is known about the determinants of variability of this parameter. We therefore evaluated the relationship between clinical characteristics and apparent Kd in 328 patients with AMI without evidence of recurrent infarction. Patients with a history of cigarette smoking within 6 months had higher rates of disappearance of CK-MB, but no relationship was found between renal function and apparent Kd. Slower rates of disappearance of CK-MB were correlated with longer times from the onset of symptoms to peak CK-MB value (p less than 0.001), while higher peak CK-MB levels were not correlated with apparent rates of enzyme clearance. Decreased rates of disappearance of CK-MB were found in patients who had congestive heart failure during or after the hospitalization (both p less than 0.05), and who died during the hospitalization or during study follow-up (both p less than 0.05). Slower rates of disappearance were also significantly correlated with lower ejection fractions on radionuclide ventriculography at 10 days (p less than 0.001) and at 3 months (p less than 0.05) after AMI. These data suggest that patients with slower rates of disappearance of CK-MB may have poorer prognoses, perhaps reflecting continuing necrosis and enzyme release from jeopardized myocardium.
authors.affiliation: Cardiovascular Division, Brigham Women's Hospital, Boston, MA 02115.
authors.forename: R T
authors.initials: RT
authors.lastname: Lee
authors.forename: T H
authors.initials: TH
authors.lastname: Lee
authors.forename: W K
authors.initials: WK
authors.lastname: Poole
authors.forename: N
authors.initials: N
authors.lastname: Gustafson
authors.forename: P H
authors.initials: PH
authors.lastname: Stone
authors.forename: A S
authors.initials: AS
authors.lastname: Jaffe
authors.forename: J E
authors.initials: JE
authors.lastname: Muller
authors.forename: B E
authors.initials: BE
authors.lastname: Sobel
authors.forename: R
authors.initials: R
authors.lastname: Roberts
authors.forename: E
authors.initials: E
authors.lastname: Braunwald
mesh_terms: D003402:Creatine Kinase / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000201:enzymology; D006801:Humans; D007527:Isoenzymes; D007674:Kidney Diseases / Q000150:complications / Q000201:enzymology; D008297:Male; D009203:Myocardial Infarction / Q000201:enzymology* / Q000209:etiology; D011379:Prognosis; D012907:Smoking / Q000009:adverse effects / Q000097:blood; D013997:Time Factors
chemical_list: D007527:Isoenzymes; D003402:Creatine Kinase