Effects of nonsurgical myocardial reperfusion on plasma creatine kinase kinetics in man

The rate and form of creatine kinase-MB (CK-MB) enzyme release following reflow to ischemic myocardium has not been specifically examined in man. In this investigation, we examined the combined CK-MB time-activity curves during acute transmural myocardial infarction (AMI) in a group of patients receiving conventional therapy (CAMI) (n = 109), and in a group of nine patients with successful reperfusion by fibrinolytic therapy (RAMI). The average time of reflow in the latter group was 4.2 ± 1.7 hours (mean ± SD) following the onset of symptoms. The average time-to-peak CK-MB for the CAMI group was 18.3 ± 5.5 hours and for RAMI it was 9.9 ± 1.1 p < 0.001). At hour 4 (about the time of reflow), the two groups had similar CK-MB elevations (CAMI = 11 ± 7, RAMI = 13 ± 11 LU/L). By hour 6 (reflow + 2 hours), the RAMI CK-MB values were significantly higher (55 ± 33 vs 20 ± 15 IU/L, p < 0.02) than the CAMI group, demonstrating an increase in the release rate of CK-MB associated with reperfusion. We conclude that in man, reflow to the ischemic myocardium significantly augments the release rate of CK-MB.