Creatine kinase MM and MB isoforms in patients receiving thrombolytic therapy and acute angiography
Creatine kinase isoforms markers, including MB2 concentration, MB2/MB1 and MM3/MM1 ratios, and M(T) index (based on the 'tissue' M subunits), were measured in serial specimens from 207 patients receiving thrombolytic therapy followed by acute angiography. The slope of release showed a significant relation (P <0.05) between MB2 concentrations and patency, graded as TIMI 0 through TIMI 3; with regard to the precatheterization/baseline ratio, the MB2 concentrations, the MM3/MM1 ratio, and the M(T) index were all significantly related to graded patency (P <0.004). Patients having patency graded as either TIMI 2/3 (Open) or TIMI 0/1 (Closed) showed highly significant differences (P <0.03) in the slope of release and precatheterization/baseline ratio for all markers except the MB2/MB1 ratio. Defining Open as TIMI 3 and Closed as TIMI 0/1/2 showed very similar results. Despite these significant differences between the Open and Closed groups after thrombolytic therapy, none of the C index calculations (areas under ROC curves) for any of the isoform markers-either alone or combined-exceeded 0.70, suggesting that these markers have limited diagnostic utility for assessing patency.
Christenson, RH; Ohman, EM; Topol, EJ; O'Hanesian, MA; Sigmon, KN; Duh -, SH; Kereiakes, D; Worley, SJ; George, BS; Pizzo, CK; Wall, TC; Califf, RM
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