NONINVASIVE DETECTION OF REPERFUSION AFTER THROMBOLYSIS BASED ON SERUM CREATINE-KINASE MB CHANGES AND CLINICAL-VARIABLES

Coronary artery patency after thrombolytic therapy has important progn ostic implications for survival after acute myocardial infarction. The ability to noninvasively identify patients early after thrombolysis m ay therefore allow other strategies, such as adjunctive therapy or res cue angioplasty, to be used to restore patency of the infarct-related artery. This study examined the use of a rapid creatine kinase (CK)-MB assay in conjunction with selected clinical variables for noninvasive detection of reperfusion after thrombolysis. Patients were enrolled i n a study evaluating accelerated plasminogen activator dose regimens w ith patency assessments by first angiographic injection during acute a ngiography at a median and interquartile range (25th and 75th percenti les) 142 (96,195) minutes after starting thrombolytic therapy. Serum C K-MB samples measured by a rapid dual monoclonal antibody assay were o btained in 207 patients before (baseline) and 30 minutes, 90 minutes, and 3 hours after starting thrombolytic therapy. In 109 patients a CK- MB sample was obtained within 10 minutes of acute angiography (angio s ample). At acute angiography the infarct-related artery was patent (Th rombolysis In Myocardial Infarction trial grade 2 to 3 flow) in 71%. B aseline CK-MB values were similar in patients with and without later r eperfusion at acute angiography: 3 (0,8) ng/ml and 0 (0,4) ng/ml, resp ectively. At acute angiography, patients with successful reperfusion h ad higher CK-MB values [46 (20,138) ng/ml] compared with patients with persistent occlusion of the infarct-related artery [8 (3,63) ng/ml;