Detection of acute myocardial infarction by a new, sensitive and rabid method for determination of creatine kinase B-subunit activity

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Abstract
An immunoinhibition method for the assay of creatine kinase (CK) isoenzymes by continuous monitoring of the ATP formation in the CK reaction by a purified firefly luciferase reagent has been developed. The sensitivity of the firefly assay of ATP makes it possible to assay CK-B subunit activity (CK-B) in serum down to 1 U/l. In healthy individuals CK-B varied between 2 and 12, mean 3 U/l. A wide range of CK-B activity was observed after acute myocardial infarction (AMI), intramuscular injection and surgery with overlapping between these different categories. Therefore the maximal change in CK-B activity (ΔCK-B) was studied in 98 patients admitted to a coronary care unit. In all 57 patients without a subsequent diagnosis of AMI according to conventional criteria ΔCK-B was < 5 U/l. In all 41 patients with AMI ΔCK-B was ≥ 5 U/l. In all healthy individuals ΔCK-B was < 2 U/l. ΔCK-B ≥ 5 U/l was found after i.m. injection and different kinds of surgery in three out of 60 patients. Thus, the present method for determination of CK activity has been shown to possess high precision in low activities, to be as rapid as conventional methods and to be simple enough to be used in a routine laboratory. With these properties the method should be suited for early diagnosis and early exclusion of even very small AMIs.

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