title: Relation of temporal creatine kinase-MB release and outcome after thrombolytic therapy for acute myocardial infarction. TAMI Study Group.
abstract: Measuring biochemical marker release after acute myocardial infarction helps in estimating infarct size and prognosis. We sought to relate in-hospital outcomes and curve-fitted creatine kinase (CK)-MB variables after thrombolysis. We measured CK-MB mass initially and at 30 and 90 minutes, and at 3, 8, and 20 hours after thrombolysis in 130 patients also undergoing cardiac catheterization at 90 minutes and at 5 to 7 days. Data were fitted, and maximums and curve areas calculated. CK-MB maximums related to infarct location (p = 0.014) and time to therapy (p = 0.002); curve area did not. Neither maximums nor curve area related to Thrombolysis in Myocardial Infarction trial flow grade at 90 minutes. Maximums related to ejection fraction at 90 minutes (p = 0.0004) and at 5 to 7 days (p = 0.0014), as did curve area (p = 0.0076 and 0.030, respectively). Maximums related to infarct zone function at 90 minutes (p = 0.024) and at 5 to 7 days (p = 0.042); curve area related only at 90 minutes (p = 0.027). Both maximums and curve area predicted congestive heart failure (p = 0.008 and p = 0.042, respectively) and a composite of congestive heart failure or death (p = 0.004 and p = 0.047, respectively); however, after adjusting for maximums, curve area no longer predicted congestive heart failure (p = 0.92). Maximums predicted the composite outcome after adjustment for curve area, and showed a trend toward predicting congestive heart failure (p = 0.089). We conclude that CK-MB maximums relate to infarct zone function, left ventricular function, and in-hospital outcomes after thrombolysis for acute myocardial infarction.
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore. rchriste@umaryland.edu
authors.forename: R H
authors.initials: RH
authors.lastname: Christenson
authors.forename: R T
authors.initials: RT
authors.lastname: Vollmer
authors.forename: E M
authors.initials: EM
authors.lastname: Ohman
authors.forename: S
authors.initials: S
authors.lastname: Peck
authors.forename: T D
authors.initials: TD
authors.lastname: Thompson
authors.forename: S H
authors.initials: SH
authors.lastname: Duh
authors.forename: S G
authors.initials: SG
authors.lastname: Ellis
authors.forename: L K
authors.initials: LK
authors.lastname: Newby
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
mesh_terms: D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D003402:Creatine Kinase / Q000097:blood*; D052279:Creatine Kinase, MB Form; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D005343:Fibrinolytic Agents; D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D010959:Tissue Plasminogen Activator