Detection of reperfusion within 1 hour after coronary recanalisation by analysis of isoforms of the MM creatine kinase isoenzyme in plasma

Early non-invasive detection of recanalisation within 1 hour of its implementation pharmacologically is needed to facilitate optimal selection of patients requiring further aggressive management of acute myocardial infarction. Recent results from studies of experimental animals suggest that prompt detection of reperfusion is possible based on analysis of sequential changes in the relative activities of individual isoforms of the MM isoenzyme of creatine kinase (CK) in plasma. To determine whether analogous changes occur in patients and whether they distinguish patients with from those without reperfusion, we evaluated CK isoform activities serially in plasma samples from 18 patients with reperfusion induced pharmacologically or by angioplasty and compared them with changes seen in 12 patients with infarction without reperfusion. In 11 of the 12 patients without reperfusion, the percentage in plasma of the MM CK isoform released from the heart, MM, did not change or decreased in the first hour. In contrast, among 17 of 18 patients with reperfusion, the percentage of MM, increased markedly over the first hour from a mean of 38 ± 2% to 53 ± 4%. Thus, 94% of patients ultimately shown to exhibit and 92% of those ultimately shown to fail to exhibit reperfusion were distinguished correctly. Accordingly, assessment of activities of MM CK isoforms in plasma should prove useful in differentiating patients with and without reperfusion at a time when additional interventions needed to consolidate the gains accompanied by initial pharmacological treatment can still be initiated effectively.