Creatine kinase MB

Use of the plasma enzyme creatine kinase Mb (CK-MB) in the diagnosis of myocardial infarction. 

Bar-Or D, Winkler JV, Vanbenthuysen K, Harris L, Lau E, Hetzel FW. Reduced albumin-cobalt binding with transient myocardial ischemia after elective percutaneous transluminal coronary angioplasty A preliminary comparison to creatine kinase-MB, myoglobin, and troponin I. Am Hear J 2001 141 985-991. 

Cardiac enzyme elevation (creatine kinase-MB, cardiac troponin) may occur on average in 20% to 30% of patients after PCI and is associated with adverse clinical outcomes in the short- and long-term (64), Magnetic resonance imaging... 

Ricciardi MJ, Wu E, Davidson CJ, et al. Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. Circulation 2001 103 2780-2783. 

Ellis SG, Chew D, Chan A, Whitlow PL, Schneider JP Topol EJ. Death following creatine kinase-MB elevation after coronary intervention identification of an early risk period importance of creatine kinase-MB level, completeness of revascularization,... 

Figure 5-1. Time-course of changes in serum cardiac troponin I and creatine kinase MB (CK-MB) following myocardial infarction and subsequent reinfarction during hospitalization. Cardiac-specific troponin I (cTNI), open squares CK-MB, filled circles. Reprinted fromApple and Murakami (2005).

Apple FS Tissue specificity of cardiac troponin I, cardiac troponin T, and creatine kinase MB. Clin ChimActa 284 151-159,1999. 

Apple FS, Murakami MM Cardiac troponin and creatine kinase MB monitoring during in-hospital... 

Apple FS, Quist HE, Doyle PJ, et al. Plasma 99th percentile reference limits for cardiac troponin and creatine kinase MB mass for use with European Society of Cardiology/American College of Cardiology consensus recommendations. Clin Chem 49 1331-1336,2003. 

Lin JC,Apple FS, Murakami MM, et al. Rates of positive cardiac troponin I and creatine kinase MB among patients hospitalized for suspected acute coronary syndromes. Clin Chem 50 333-338, 2004. 

Creatine kinase (CK) occurs in high concentrations in the brain, cardiac and skeletal muscle and is elevated in the blood with muscle damage. A rise in CK is seen in acute myocardial infarction but also in other conditions. A more specific marker is creatine kinase MB (CK-MB), which is an isoenzyme of creatine kinase that is more specific for cardiac muscle damage. CK or CK-MB will rise approximately 4 hours after an acute cardiac event and will reach a peak after approximately 24 hours and will remain raised for 3-4 days. 

Tests to distinguish between angina and a myocardial infarction involve a full ECG and measurements of specific cardiac enzymes, such as creatine kinase MB and troponin I and T. 

Q4 Cardiac enzymes are released into the blood following heart muscle damage during a heart attack. Creatine kinase, particularly its MB isoenzyme, is one of the most specific of these enzymes, which reaches a peak 24 hours after infarction. It rises and then falls within the first 72 hours of the heart attack. Aspartate transaminase is also released, but levels of this enzyme can be raised in several other conditions, so it is less specific than creatine kinase MB. Troponin T is also specific for myocardial damage and is raised for approximately two weeks following infarction. Finding a high concentration of these enzymes in a patient s blood therefore supports the evidence obtained from the ECG and confirms that the patient has suffered a myocardial infarction. 

A 31-year-old woman suddenly developed central chest pain, with a normal electrocardiogram. Changes in troponin and creatine kinase MB were consistent with acute myocardial infarction. Drug screening was positive for amphetamines and barbiturates. Coronary angiography showed an aneurysm with 99% occlusion of the proximal left circumflex coronary artery and extravasation of contrast material. A stent was inserted percutaneously and antegrade flow was achieved without residual stenosis. 

Chemical markers are released into the bloodstream following injury of the cardiac muscle. Three types of troponin, as well as elevated creatine kinase-MB (CK-MB) levels, are indicators of cardiac tissue damage (Apak et al., 2005 Q Brien, 2008). 

E252 Ektachem Creatine Kinase-MB Test Methodology MP2-48 (1986). 

E328 Endahl, G.L., Boyd, T., Cuthbertson, C. and Matthews, W.S. (1987). Evaluation of Kodak thin-film slides for theophylline, magnesium and creatine kinase-MB. Clin. Chem. 33, 951-952, Abstr. 349. 

E459 Mayer, T.K., Kubasik, N.P., Murray, C., Cordy, P.A. and D Souza, J.P. (1988). Clinical correlation of the Kodak Ektachem creatine kinase MB slide in patients with suspected acute myocardial infarction. Clin. Chem. 34, 1282. Abstr. 632. 

E489 Sima, P.D., Kahn, S.E. and Bermes, E.W. (1988). Performance of the Kodak Ektachem DT60 analyzer for analysis of phosphate and magnesium and the DTSC module for analysis of lipase, creatinine, and creatine kinase (MB). Clin. Chem. 34,1195, Abstr. 206. 

E632 Jensen, A.E., Reikvam, A., NordgSrd, Pedersen, K.G. and Asberg, A. (1990). Diagnostic accuracy of Kodak creatinine kinase MB, Stratus creatine kinase MB, and lactate dehyrogenase isoenzyme 1 in serum after acute myocardial infarction. Clin. Chem. 36, 1847-1848. 

ST53 Butch, A.W., Goodnow, T.T., Brown, W.S., McCellan, A., Kessler, G. and Scott, M.G. (1989). Stratus automated creatine kinase-MB assay evaluated Identification and elimination of falsely increased results associated with a high-molecular-mass form of alkaline phosphatase. Clin. Chem. 35, 2048-2053. 

ST71 Ryan, F., Scott, D., Gregory, M. and Turner, M. (1989). Measurement of creatine kinase MB by the Baxter Stratus fluorometric analyzer. Clin. Chem. 35, 1123, Abstr. 271. 

Aboukhamis, S., Garcera, Y., Gourmelin, Y. and Truchaud, A. (1990). Clinical evaluation of the Stratus Baxter CKMB. Clin. Chem. 36, 1188, Abstr. 1102. Anderson, P.H. and Stickel, S.A. (1990). Clinical comparison of the Baxter Stratus creatine kinase MB and the Roche Isomune CK-MB in a varied hospital population. Clin. Chem. 36,1132, Abstr. 842. 

ST79 Chapelle, J.-P. and El Allaf, M. (1990). Automated quantification of creatine kinase MB isoenzyme in serum by radial partition immunoassay, with use of the Stratus analyzer. Clin. Chem. 36, 99-101. 

ST80 Christenson, R.H., Clemmensen, P., Ohman, E.M., Toffaletti, J., Silverman, L.M., Grande, P., Vollmer, R.T. and Wagner, G.S. (1990). Relative increase in creatine kinase-MB isoenzyme during reperfusion after myocardial infarction is method dependent. Clin. Chem. 36, 1444-1449. 

STN2 Anderson, P.H., Stickel, S.A. and Nadkami, S.R. (1991). An evaluation of new calibrators for the creatine kinase MB isoenzyme on the Baxter Stratus. Clin. Chem. 37, 912-913, Abstr. 18. 

STN5 Christenson, R.H., Kazanzides, D., Pizzo, C.K. and Nadkami, S. (1991). Verification of plasma based calibrators for use with the Stratus creatine kinase-MB assay. Clin. Chem. 37, 912, Abstr. 15. 

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