Peak creatine kinase as a measure of effectiveness of thrombolytic therapy in acute myocardial infarction |
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| Authors: | J M Gore R Roberts S P Ball A Montero R J Goldberg J E Dalen |
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| Affiliation: | 1. From the Departments of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts USA;2. From the Baylor College of Medicine, Houston, Texas USA;1. Department of Chemical and Food Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil;2. BRF S.A., São Paulo, Brazil;3. Department of Biological and Agricultural Engineering, University of California Davis, Davis, USA;1. Department of Cell Biology, Army Medical University, Chongqing, 400038, China;2. Jinfeng Laboratory, Chongqing, 400038, China;3. Department of Pathophysiology, Huazhong University of Science and Technology, Wuhan, 430030, China;4. State Key Laboratory of Trauma, Burn and Combined Injury, Chongqing, 400038, China;1. Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, School of Medicine, National University of Ireland Galway, Galway, Ireland;2. Department of Nephrology, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland;1. University of Washington, Seattle, WA;2. AdventHealth for Children, Orlando, FL;3. University of Arkansas for Medical Sciences, Little Rock, AR;4. University of Louisville, Louisville, KY;5. Methodist Children''s Hospital, San Antonio, TX;6. Children''s Hospital and Clinics of Minnesota, Minneapolis, MN;7. University of Utah, Salt Lake City, UT;8. Maria Fareri Children''s Hospital at Westchester Medical Center, Valhalla, NY;9. Wake Forest School of Medicine, Winston-Salem, North Carolina;10. University of Minnesota Masonic Children''s Hospital, Minneapolis, MN;11. Children''s Minnesota, St Paul, MN;12. Beth Israel Deaconess Medical Center, Boston, MA;13. Prentice Women''s Hospital, Chicago, IL;14. University of Florida, Gainesville, FL;15. Johns Hopkins University, Baltimore, MD;16. University of New Mexico, Albuquerque, NM;17. Children''s Hospital of the University of Illinois, Chicago, IL;18. South Miami Hospital, South Miami, FL;19. Johns Hopkins All Children''s Hospital, St Petersburg, FL;20. Boston University Medical Center, Boston, MA;21. University of North Carolina School of Medicine, Chapel Hill, NC;22. University of California San Francisco School of Medicine, San Francisco, CA;23. National Institute of Neurological Disorders and Stroke, Bethesda, MD;24. University of Rochester Medical Center, Rochester, NY;25. Stanford University and Lucile Packard Children''s Hospital, Palo Alto, CA;26. Vanderbilt University Medical Center, Nashville, TN;27. University of Chicago, Chicago, IL;1. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL;2. University of Washington, Seattle, WA;3. University of Rochester/Golisano Children''s Hospital, Rochester, NY;4. Department of Pediatrics, University of Washington/Seattle Children''s Hospital, Seattle, WA;5. Department of Pediatrics, Cincinnati Children''s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH;1. Department of Pediatrics, University of Washington, Seattle, WA;2. Department of Biostatistics, University of Washington, Seattle, WA;3. Department of Pediatrics, University of Utah, Salt Lake City, UT;4. Department of Pediatrics, University of Minnesota, MN |
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| Abstract: | As part of the National Heart, Lung, and Blood Institute multicenter Thrombolysis in Myocardial Infarction Trial, the time to peak plasma creatine kinase (CK) activity as a marker of reperfusion in 272 patients with validated acute myocardial infarction was analyzed. Patients were treated with either tissue-type plasminogen activator or streptokinase by intravenous administration. All patients underwent acute coronary angiography. The infarct-related artery was identified and thrombolytic therapy administered. Reperfusion at 90 minutes was documented by angiography. CK was determined before institution of therapy and every 4 hours thereafter for the first 24 hours. Patients were classified into 3 groups for comparative purposes: group 1--occlusion with no reperfusion (n = 119); group 2--occlusion with reperfusion (n = 98); and group 3--subtotal occlusion (n = 55). Early (within 4 hours after treatment) and late (more than 16 hours after treatment) peaking of CK differentiated patients with drug-induced perfusion from those without reperfusion. Although peak CK between 5 and 11 hours after drug treatment did suggest perfusion through the infarct-related artery, it did not differentiate between drug-induced and spontaneous reperfusion. Clinically, early peak CK is a useful noninvasive means of assessing coronary artery patency. However, in clinical trials assessing drug therapy, the use of peak CK may overestimate drug effectiveness by including patients with spontaneous reperfusion. |
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