Prompt detection of coronary recanalization by analysis of rates of change of concentrations of macromolecular markers in plasma

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Abstract
Sequential changes in the concentration in plasma of isoforms of MM creatine kinase and of myoglobin have shown promise for detection of recanalization of occluded coronary arteries because of their rapid release from reperfused myocardium and the relatively slow rate of posttranslational modification of the tissue isoform of MM creatine kinase (MM3) in plasma. Our study was performed to determine whether 1) assessment of rates of change compared with absolute concentrations of macromolecular markers improve detection and 2) use of more than one marker increases accuracy. Temporal changes in both markers were characterized in dogs with experimentally induced coronary occlusion and recanalization after 2 hours and in 32 patients with acute myocardial infarction who were treated with tissue-type plasminogen activator. Rates of increase in the concentration of myoglobin and the percentage of MM creatine kinase attributable to its tissue isoform in plasma distinguished dogs with recanalization (n=7) from those with persistent coronary occlusion (n=6) within 30 minutes. Based on analysis of the data from the 17 patients in whom patency of the infarct-related artery could be determined angiographically (n=11) or from concordant, indirect, clinical criteria, indexes of recanalization were defined (mean rates of increase,-1 SD) for each macromolecular marker and were found to closely resemble those in dogs. In 15 additional patients who had not had early angiography, estimates with the two markers of the frequency of recanalization within 1 hour after the onset of treatment with tissue-type plasminogen activator were concordant in 75%. The type of artifact that may distort results with each of the two macromolecular markers studied differs (eg, altered renal blood flow potentially influencing myoglobin and altered carboxypeptidase N activity potentially affecting the percentage of MM creatine kinase attributable to its tissue isoform). However, our results indicate that conjoint assessment with both is likely to provide robust and prompt noninvasive detection of early recanalization after coronary thrombolysis.

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