Serum enzyme determinations in the diagnosis of acute myocardial infarction: an update

Serum CK-MB and LD-1 have proved extremely useful in the diagnosis and differential diagnosis of acute myocardial infarction. However, CK-MB is present in skeletal muscle and can be released during ischemic attacks; thus, abnormal serum CK-MB activities cannot be equated with myocardial injury. Even wider is the distribution of LD-1, which is found particularly in erythrocytes and renal cortex; hence, an abnormal LD-1 level also cannot be equated with myocardial injury. The method of choice and the final arbiter for the CK and LD isoenzymes is electrophoresis. The possibility of interpreting the results visually fulfills, in part, quality-control needs, and makes the technique suitable for small and large laboratories. Extreme analytic sensitivity is not needed, and electrophoresis provides clinically useful and acceptable results.

Evaluation of an immunoradiometric assay specific for the CK-MB isoenzyme for detection of acute myocardial infarction

Clinical evaluation of patient's symptoms, electrocardiographic changes and increased serum enzyme levels, specifically creatine kinase (CK)-MB by electrophoresis, are established as the primary diagnostic indicators for myocardial infarction (MI). Two hundred fifteen patients were evaluated in this study. Of these patients, 102 were admitted to the coronary care unit and 113 were admitted to the emergency room and screened for possible MI. The immunoradiometric assay used in this study was a double antibody "sandwich" technique, which utilizes antibody to the M and B monomers of the CK isoenzymes. This assay is specific for the CK-MB isoenzyme, which is present in increased levels in MI. The intraassay coefficients of variation for 30 samples were 11.7% (mean 4.1 equivalent units [EU]/liter) and 8.4% (mean 15.4 EU/liter) and the interassay coefficients of variation for 30 samples were 11.1% (mean 2.6 EU/liter) and 8.1% (mean 13.6 EU/liter). The diagnostic sensitivity, specificity and accuracy in this study was 100%, respectively. The CK-MB by the immunoradiometric assay was found to be significantly more accurate than electrophoresis and, therefore, a reliable and also technically simpler replacement for electrophoresis.

Creatine kinase isoenzymes and prostatic carcinoma: metastatic disease or acute myocardial infarction?

The measurement of creatine kinase isoenzymes, particularly the MB fraction, is a major determinant for acute myocardial infarction. Patients with metastatic carcinoma of the prostate may have an elevated serum creatine kinase-BB fraction, which by some automated laboratory techniques may be read mistakenly as creatine kinase-MB. We report such a case and discuss the creatine kinase isoenzyme measurement.

Immunoassay of enzymes--an overview

Immunochemical techniques with enzymes as the antigen have grown in frequency during the last few years. These techniques have allowed evaluation of enzymes in the presence of endogenous inhibitors. Among those enzymes measured by immunochemical techniques and which have found diagnostic application, mention will be made of alkaline phosphatase (with particular reference to the intestinal, placental, and Regan isoenzymes), lactate dehydrogenase (in which renewed interest has developed due to techniques for specifically measuring the LD-1 isoenzyme), aspartate aminotransferase (of which the cytosolic and mitochondrial forms can now be independently measured by immunochemical techniques), acid phosphatase (for which a specific immunochemical assay for the prostatic enzyme has been widely introduced in diagnostic laboratories), and creatine kinase (for which a variety of immunochemical techniques to measure the M- and B-subunits are now part of standard laboratory assays). Other enzymes which will be discussed in this review include phosphohexose isomerase, amylase, ribonuclease, and lysozyme (muramidase). Finally, the use of enzymes, particularly asparaginase, in the chemotherapy of cancer will be outlined.