CREATINE KINASE-MB FRACTION AND CARDIAC TROPONIN-T TO DIAGNOSE ACUTE MYOCARDIAL-INFARCTION AFTER CARDIOPULMONARY-RESUSCITATION

Objectives. This study sought to evaluate the diagnostic value of the biochemical markers creatine kinase (CK), creatine kinase-MB fraction (CK-MB) and cardiac troponin T (cTNT) to diagnose acute myocardial inf arction (AMI) after cardiopulmonary resuscitation (CPR), Background. E levations of CK and CK-MB after CPIR are a frequent finding and might be associated with ischemic myocardial injury, as well as physical tra uma to the chest. Methods. Patients who had cardiac arrest and primary successful resuscitation were included in the study. The diagnosis of AMI was confirmed or ruled out by means of typical electrocardiograph ic findings, thallium-201 myocardial scintigraphy or autopsy, if death occurred during the hospital period, in 39 primary survivors of sudde n cardiac death. In 24 patients (62%) the diagnosis of AMI was establi shed. Serum cTNT, CK and CK-MB were measured, and the CK-MB/CK ratio w as calculated on admission and after 12 h, Results. On admission all m arkers of myocardial injury proved to be weak methods for the diagnosi s:pf AMI. After 12 h cTNT as well as CK-MB exhibited a similar diagnos tic performance; CK and the CK-MB/CK ratio proved to be worthless, Sen sitivity and specificity for a cTNT cutoff value of 0.6 ng/ml, 12 h af ter cardiac arrest, were 96% and 80%, respectively, For a CK-MB cutoff value of 26 U/liter, sensitivity was 96% and specificity was 73%. Con clusions. Cardiac TNT and CK-MB are valuable tools in detecting AMI as the cause of sudden cardiac death, However, there is a considerable l ack of sensitivity and specificity. Cardiac injury is probably caused not only by AMI, but also by myocardial damage related to CPR efforts.