Creatine Kinase Ratio Research Articles

Diagnostic value of the creatine kinase-MB/creatine kinase and neutrophil/lymphocyte ratios in acute myocardial infarction

ObjectiveTo investigate the clinical significance of the creatine kinase (CK)-MB/total CK ratio, neutrophil/lymphocyte ratio (NLR) and red blood cell distribution width in acute myocardial infarction (AMI).MethodsA retrospective analysis was conducted of 196 AMI cases from our hospital’s cardiology department; healthy people were selected over the same period as the control. The two groups’ test indexes were compared through multivariate logistic regression analysis to screen for AMI risk factors; the receiver operating characteristic (ROC) curve was used to evaluate their AMI predictive values.ResultsThe serum CK, CK-MB, CK index, neutrophils and NLR values in the AMI group were significantly higher compared with those in the control group (p < 0.05); however, the levels of serum lymphocytes were significantly lower compared with those in the control group (p < 0.05). Multivariate logistic regression analysis showed that elevated CK-MB and NLR levels were risk factors for AMI (p < 0.05). The ROC curve showed that the area under the curve of the NLR and CK levels were 0.917 and 0.594, respectively.ConclusionThe CK index and NLR have a clinical predicting value for AMI and could be used as a clinical auxiliary diagnostic index for the assessment of patients with AMI.

Evaluation of creatine kinase (CK)-MB to total CK ratio as a diagnostic biomarker for primary tumors and metastasis screening

ObjectiveCreatine kinase (CK) and its myocardial band isoenzyme (CK-MB) were considered important diagnostic indicators for identifying suspected acute myocardial infarction. However, the serum level of CK-MB is frequently exaggerated in some pathological states without cardiogenic damage, like cancer. Sometimes, the CK-MB level is even greater than the total CK. This study intended to investigate the association between malignancy and an abnormally high ratio of CK-MB to total CK (CK-MB/CK) and to assess the diagnostic relevance of this ratio as a biomarker for cancer. MethodsPatients hospitalized between September 2019 and September 2022 at Shandong Provincial Qianfoshan Hospital (Jinan, Shandong, China) with serum CK-MB activity greater than total CK activity (CK-MB/CK > 1.0) were recruited as research subjects. Then the demographic and clinical characteristics of these patients were systemically analyzed. The correlation between clinical characteristics (such as cancer types, tumor locations, and tumor metastasis) and laboratory test results (such as serum CK-MB activity, total CK activity, and the CK-MB/CK ratio) was also investigated. ResultsWe found that over 44% of the patients with CK-MB/CK > 1.0 were diagnosed with malignancies, and the CK-MB/CK ratio in malignancies patients was significantly higher than in non-malignancies patients. The increase of CK-MB/CK ratio was most obvious in patients with colorectal carcinoma and prostatic carcinoma. Additionally, extremely elevated CK-MB/CK ratios were observed in individuals with metastatic neoplasms, especially in those who suffered from numerous sites of metastasis. ConclusionsThe serum CK-MB/CK ratio can be utilized as a readily accessible supplement diagnostic biomarker in screening for primary and metastatic cancers.

In primary total hip arthroplasty, the direct anterior approach leads to higher levels of creatine kinase and lower levels of C-reactive protein compared to the posterolateral approach: a propensity score matching analysis of short-term follow-up data

BackgroundThis retrospective study compares the invasiveness of the direct anterior approach (DAA) and the posterolateral approach (PLA) in total hip arthroplasty (THA) by assessing three widely used inflammation-related serum markers in the first ten post-operative days.MethodsThe database of our institution was mined for primary THAs conducted by the DAA or the PLA from February 2020 to June 2022. Demographics and creatine kinase (CK), C-reactive protein (CRP), and white blood cells were compared. Propensity Score Matching (PSM) analysis (1:1 ratio) was conducted based on multiple variables.ResultsPSM analysis yielded 44 pairs of DAA and PLA patients. CK was significantly higher (p < 0.001) in the DAA than in the PLA group on postoperative day (POD) 2, 5 and 10. The POD2, POD5 and POD10 CK/preoperative CK ratio was 12.9, 5.0 and 0.8 in DAA and 8.8, 3.3 and 0.6 in PLA (p = 0.017, p = 0.012 and p = 0.025, respectively). The POD2, POD5 and POD10 CRP/preoperative CRP ratio was 95.1, 65.6 and 22.8 in PLA and 34.7, 23.3 and 8.9 in DAA (p < 0.001, p = 0.002 and p < 0.001, respectively).ConclusionPSM analysis of early postoperative CK and CRP values demonstrated that the DAA should be considered as a less stressful approach, not as a muscle-sparing or a minimally invasive THA approach.

A high serum creatine kinase (CK)-MB-to-total-CK ratio in patients with pancreatic cancer: a novel application of a traditional marker in predicting malignancy of pancreatic masses?

BackgroundThe finding that some benign pancreatic masses mimic the imaging appearance of carcinomas poses a challenge for pancreatic surgeons. Preoperative markers that assist in the diagnosis are critical under this circumstance. Abnormal serum creatine kinase (CK) isozyme levels were reported in cancer patients, and this study aimed to explore the potential value of the CK-MB-to-total-CK ratio (CK ratio) in differentiating pancreatic cancer (PC) from benign masses when combined with carbohydrate antigen 19-9 (CA19-9).MethodsA total of 190 patients primarily diagnosed with pancreatic masses were retrospectively reviewed and assigned to the PC group and the benign pancreatic mass (BPM) group. Sixty-eight controls were enrolled for comparison. Levels of preoperative parameters, including total serum CK, CK-MB, absolute neutrophil count, absolute lymphocyte count, albumin, and CA19-9, were recorded as well as pathological information. A logistic regression model was established to assess the application value of the combination of CA19-9 and the CK ratio in diagnosis. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic value of the markers.ResultsThe CK ratio was significantly elevated in the PC group compared with the BPM group (P < 0.001). In the multivariate analysis, a CK ratio greater than 0.220 was a statistically significant variable for predicting malignancy of pancreatic masses (P=0.001). Patients with stage III/IV PC had a higher CK ratio than those with stage I/II PC (P<0.01). Combined detection of CA19-9 and the CK ratio produced an increased Youden index (0.739 vs. 0.815) with improved sensitivity (82.2% vs. 89.8%).ConclusionsThe CK ratio is elevated in patients with pancreatic adenocarcinoma and is an independent factor predicting pancreatic adenocarcinoma. The CK ratio augments the diagnostic capacity of CA19-9 in detecting malignancy.

CREATININE AND CREATINE KINASE RATIO IN BLOOD OF DIFFERENT BODY TYPES - A NEW APPROACH.

Purpose: The inconsistencies and variations of creatine kinase level due to modifiable and non-modifiable factors were the basis of this study. The aim was to find out the relationships between creatinine and creatine kinase in the blood of somatotypes. &#x0D; &#x0D; Methods: The 122 males, aged 10 to 20 years, were classified according to their somatotypes. Somatotypes were measured by the ISAK method. By standard laboratory methods, creatinine and creatine kinase estimate. The IBM SPSS version 24 is used for calculation. One way ANOVA followed by post hoc tests was performed to compare the variables among the three groups (p&lt;0.05).&#x0D; &#x0D; Results: Creatinine level in the blood insignificantly deferred among the three somatotypes. The significant differences (p&lt;0.05) were found in creatine kinase level in the blood and creatinine/creatine kinase ratio among the three dominant Somatotypes. Creatine Kinase was significantly higher in Ectomorphs (212 U/L) than Endomorphs. Ectomorphs and mesomorphs have crossed normal creatine kinase levels (35 -175 U/L). The creatinine/creatine kinase ratio was found highest in endomorphs and lowest in the ectomorphs and significantly differed in three Somatotypes.&#x0D; &#x0D; Conclusion: Creatinine production remains the same, indicating production of Creatinine is independent of specific body types. A significant higher Creatine Kinase level in Ectomorphs over Endomorphs showed fat content was not associated with it. Significant differences in Creatinine / Creatine Kinase ratio among Somatotypes suggested its relevance between cellular and morphological relationships and might uses as biomarkers.

Post-match recovery profile of leukocyte cell subsets among professional soccer players

This study assessed the impact of cumulative match time on the distribution of CD45+ cell subtests in the capillary blood of professional soccer players. Twenty-two males (aged 18–30 years) took part in the 36-week study. Participants playing up to 540 in cumulative match time and less than 30 min in each single match during the observation period formed the control group. White blood cell (WBC) phenotyping and creatine kinase (CK) plasma activity analyses were performed. Also, counts for WBC subsets were determined. No significant differences in the hematological parameters or lymphocyte and NK cell percentages were observed between the control and study groups. Changes in the T cell percentage were significant during weeks 11 and 30 and in Th and Tc cell percentages during weeks 2 and 26. Significant correlations were found between the cumulative match time and Th, NK, and B cell percentages; monocyte counts; and CK activity in the control group. However, for the study group, correlations were found between cumulative match time and Th, Tc, and B cell percentages; CK activity; and the CK ratio. Our study suggests that the distribution of CD45+ cells might be a useful tool for monitoring the immune status of professional soccer players.

Impact of periprocedural myocardial infarction on 10-year mortality after percutaneous coronary intervention or coronary artery bypass grafting for multivessel or left main coronary artery disease

Abstract Background Periprocedural myocardial infarction (PMI) occurs frequently after both percutaneous coronary intervention (PCI) and bypass grafting surgery (CABG) in patients with complex coronary artery disease (CAD), and PMI has been shown to have a detrimental impact on mortality. On the other hand, long-term impact of PMI on mortality has not been fully evaluated. Purpose This study aimed to assess the impact of PMI according to SCAI definition on 10-year all-cause death in patients with complex CAD. Methods The SYNTAX Extended Survival (SYNTAXES) study evaluated vital status up to 10 years in 1800 patients with de novo three-vessel disease and/or left main coronary artery disease randomized to treatment with CABG or PCI in the SYNTAX trial. Blood was sampled for creatine kinase (CK) pre- and post-revascularisation, and the cardiac specific MB iso-enzyme (CK-MB) was determined only if the CK ratio ≥2 x the upper limit of normal (ULN). If the CK ratio &amp;lt;2 ULN, CK-MB assessment was not mandated. In this analysis, patients with at least one blood sampling within 48 hours of the procedure were included. PMI was defined as follows; peak CK-MB measured within 48 hours of the procedure ≥10 x ULN, or ≥5 x ULN with new Q-waves in 2 contiguous leads or new persistent left bundle branch block. Results Of 1800 patients, 1679 (93.2%) patients were included. Of 877 patients treated with PCI, PMI occurred in 26 patients (3.0%), whereas 14 (1.7%) PMIs were observed in 802 patients treated with CABG. Compared with patients without PMI, patients with PMI presented with unstable angina more frequently (45.0% vs. 28.7, p=0.033), and had a higher rate of bifurcation lesion (87.5% vs. 72.5, p=0.046). PMI was associated with a higher all-cause mortality at 10 years compared with no PMI (55.3% vs. 25.4%; Log-rank p&amp;lt;0.001, Figure), which was mainly driven by a high mortality rate within 1 year. In patients undergoing PCI, the mortality rates were significantly higher in patients with PMI not only within 1 year (Log-rank p&amp;lt;0.001) but also beyond one year (Log-rank p=0.016), compare to patients without PMI (Figure). On the other hand, in patients undergoing CABG, a higher mortality rate in patients with PMI was observed until 1 year (Log-rank p&amp;lt;0.001), but the impact of PMI on mortality beyond one year after CABG subsided (Log-rank p=0.308) (Figure 1). Conclusion PMI was associated with a poor prognosis at 10 years. The impact of PMI on mortality was strong within one year. Of note, the impact of PMI on mortality persisted beyond 1 year only in patients undergoing PCI. Patients who were treated with PCI and suffered PMI need careful follow-up beyond one year after revascularization. Figure 1 Funding Acknowledgement Type of funding source: None

Initial creatine kinase level as predictor for delayed neuropsychiatric sequelae associated with acute carbon monoxide poisoning.

The primary goal of treating patients with carbon monoxide (CO) poisoning is preventing delayed neuropsychiatric sequelae (DNS). It is difficult to predict DNS because there is no precise diagnostic method in the early phase of CO poisoning. In this study, we aimed to investigate the optimal cut-off value for creatine kinase level to predict DNS. This retrospective observational study included patients with CO poisoning visiting a single tertiary center from January to July 2018. They were divided into two groups according to the presence of DNS. We compared baseline characteristics with variables that could affect the presence of DNS. The optimal cut-off value of initial creatine kinase concentration for DNS was calculated. Additionally, multivariate analysis was performed to confirm whether creatine kinase could be an independent predictor of DNS. Of the 138 patients, 12 patients developed DNS. Univariate analysis showed significant differences in the Glasgow Coma Scale, duration of exposure, laboratory tests, abnormal finding on MRI in acute phase, the number of hyperbaric oxygen therapy sessions, and duration of hospitalization. Receiver operating characteristic analyses of creatine kinase were performed (AUC=0.92; 95% CI, 0.86-0.96) with a cut-off value of 1603U/L; DNS was predicted with a sensitivity of 91.7% and specificity of 88.1%. In multivariate analysis, the adjusted odds ratio of creatine kinase was 51.516. In patients with CO poisoning, initial creatine kinase concentrations of >1603U/L can be used as an independent predictor of DNS.

Ratio of Creatine Kinase to Alanine Aminotransferase as a Biomarker of Acute Liver Injury in Dystrophinopathy.

Objective To investigate the ratios of creatine kinase (CK) to aminotransferases as biomarkers of acute liver injury in dystrophinopathy. Methods C57 and mdx (dystrophic) mice were treated with a hepatotoxic reagent D-galactosamine (D-GalN). The degrees of liver and muscle injury were assessed using histological examinations. To examine whether serum CK-adjusted aminotransferase levels could indicate liver status in dystrophic mice, the CK/alanine aminotransferase (ALT) and CK/aspartate aminotransferase (AST) ratios were analyzed. Furthermore, we enrolled 658 male patients with dystrophinopathy and 378 male patients without muscle and liver injury as control, whose serum ALT, AST, and CK levels were examined. Results Animal experiments indicated that D-GalN treatment could induce acute liver injury but not muscle injury. Additionally, D-GalN decreased the CK/ALT and CK/AST ratios in both C57 mice and mdx mice (P < 0.001). However, there was an overlap of the CK/AST ratio between dystrophic mice with and without acute liver injury. In patients with dystrophinopathy, CK-adjusted ALT diminished the variability associated with age, genotype, clinical phenotype, and motor function (P > 0.05). Conclusions CK/ALT is a potential biomarker for the differential evaluation of acute liver injury in dystrophic mice, which highlights the value to further evaluate the practice of CK/ALT in dystrophinopathy patients.

Mortality impact of post-discharge myocardial infarction size after percutaneous coronary intervention: a patient-level pooled analysis from the 4 large-scale Japanese studies.

It is unknown whether there is a threshold of creatine kinase (CK) or CK-MB affecting the subsequent mortality for post-discharge myocardial infarction (PDMI) after percutaneous coronary intervention. Current study sought to evaluate the impact of PDMI. The study population included 30,051 patients with successful coronary stenting and discharged alive in the pooled patient-level database of 4 Japanese studies (j-Cypher registry, CREDO-Kyoto PCI/CABG registry cohort-2, RESET, and NEXT). During 4.4 ± 1.4year follow-up, 915 patients experienced PDMI (cumulative 5-year incidence of 3.6%). Among 466 patients with available peak CK ratio (peak CK/upper limit of normal), peak CK ratio (< 3) was present in 21% of patients, while peak CK ratios (≥ 3 and < 5), (≥ 5 and < 10), (≥ 10 and < 30), and (≥ 30) were present in 17, 25, 30, and 7.3% of patients, respectively. The excess mortality risk of patients with relative to those without PDMI for subsequent mortality was significant (adjusted HR 5.12, 95% CI 4.52-5.80, P < 0.001) by the Cox model with PDMI incorporated as the time-updated covariate. However, the mortality risk of patients in the smallest peak CK ratio category (< 3) was insignificant (HR 0.85, 95% CI 0.43-1.71, P = 0.65). In conclusion, despite significant overall mortality risk of PDMI, the mortality risk of small PDMI was similar to that of no PDMI, suggesting the presence of some threshold about infarct size influencing mortality.Trial registrations The Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial (RESET); NCT01035450 and NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial (NEXT); NCT01303640. J-Cypher and CREDO-Kyoto PCI/CABG registry cohort 2 were not registered into clinical trial database.

Sporadic acute benign calf myositis: Systematic literature review

Acute benign calf myositis is a rare infection-associated syndrome presenting with calf pain that occurs in epidemics or sporadically. Epidemic cases are usually associated with influenza virus type B. Sporadic cases, however, might be associated with a large number of microorganisms. Furthermore, during an outbreak there is a great alertness that promotes earlier diagnosis. In contrast, there is likely a lower awareness regarding the sporadic form, compromising early and correct diagnosis. In order to characterize the sporadic form of acute calf myositis and increase the knowledge of this condition, we systematically reviewed the literature reporting sporadic cases. We identified 72 reports, including 451 patients, 325 males and 126 females. Sporadic acute benign calf myositis affected subjects ≤18 years of age (N = 450; 99%), who followed a prodromal flu-like illness (N = 411; 91%), presented with pain and tenderness affecting only the calves for ≤1½ weeks (N = 441; 99%) and was never complicated by kidney involvement. The creatine kinase ratio was ≥10 in 310 (70%) out of 444 cases. Microbiological studies identified an infectious trigger in 181 cases, mostly influenza virus (type B more frequently than type A), Dengue, Ebstein–Barr or Parainfluenza virus and Mycoplasma pneumoniae. Sporadic acute benign calf myositis is a self-limited condition that can usually be diagnosed on a clinical basis. Unlike the epidemic form, many cases are due to microorganisms other than influenza virus B or A.

Effects of sinomenine on hind limb ischemia-reperfusion injury and expression of Bcl-2 and Bax in skeletal muscle cells of rats

Objective To investigate the effects of sinomenine on hind limb ischemia-reperfusion (I/R) injury and expression of Bcl-2 and Bax in skeletal muscle cells of rats. Methods Fifty-four healthy adult male Wistar rats, aged 6-8 weeks, weighing 180-220 g, were divided into 3 groups (n=18 each) using a random number table: sham operation group (group S), group I/R and sinomenine group (group SIN). The rats were subjected to 4 h of ischemia on the proximal part of the right hind limb using elastic rubber bands followed by reperfusion in I/R and SIN groups.Sinomenine 60 mg/kg was injected intraperitoneally at 30 min before reperfusion in group SIN, and the equal volume of normal saline was given instead of sinomenine at 30 min before reperfusion in S and I/R groups.Immediately after onset of reperfusion and at 4 and 24 h of reperfusion, blood samples were collected from the cardiac apex to measure the concentrations of serum lactate dehydrogenase (LDH) and creatine kinase (CK). The animals were sacrificed immediately after blood sampling, and the gastrocnemius specimens of the hind limb were immediately removed for determination of the wet to dry weight ratio (W/D ratio) and expression of Bcl-2 and Bax in gastrocnemius cells (by immunohistochemistry) and for examination of the pathological changes after haematoxylin and eosin staining.The Bcl-2/Bax ratio was calculated. Results Compared with group S, the gastrocnemius W/D ratio and concentrations of serum LDH and CK were significantly increased, the expression of Bcl-2 was significantly down-regulated, the expression of Bax was significantly up-regulated, and the Bcl-2/Bax ratio was significantly decreased in I/R and SIN groups (P<0.05). Compared with group I/R, the gastrocnemius W/D ratio and concentrations of serum LDH and CK were significantly decreased, the expression of Bcl-2 was significantly up-regulated, the expression of Bax was significantly down-regulated, and the Bcl-2/Bax ratio was significantly increased in group SIN (P<0.05). The pathological changes of the gastrocnemius were significantly attenuated in group SIN as compared with group I/R. Conclusion Sinomenine can attenuate hind limb I/R injury, and the mechanism may be related to maintenance of the balance between Bcl-2 and Bax and to inhibition of apoptosis in skeletal muscle cells of rats. Key words: Sinomenium; Reperfusion injury; Extremities; Proto-oncogene proteins c-bcl-2; bcl-2-associated X protein

Total flavonoid extract from Coreopsis tinctoria Nutt. protects rats against myocardial ischemia/reperfusion injury.

This study aimed to evaluate the protective effects of total flavonoid extract from Coreopsis tinctoria Nutt. (CTF) against myocardial ischemia/reperfusion injury (MIRI) using an isolated Langendorff rat heart model. Left ventricular developed pressure (LVDP) and the maximum rate of rise and fall of LV pressure (±dp/dtmax) were recorded. Cardiac injury was assessed by analyzing lactate dehydrogenase (LDH) and creatine kinase (CK) released in the coronary effluent. Superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and malondialdehyde (MDA) levels were determined. Myocardial inflammation was assessed by monitoring tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), interleukin-8 (IL-8), and interleukin-6 (IL-6) levels. Myocardial infarct size was estimated. Cell morphology was assessed by 2,3,5-triphenyltetrazolium chloride and hematoxylin and eosin (HE) staining. Cardiomyocyte apoptosis was determined by terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) staining. Pretreatment with CTF significantly increased the heart rate and increased LVDP, as well as SOD and GSH-Px levels. In addition, CTF pretreatment decreased the TUNEL-positive cell ratio, infarct size, and levels of CK, LDH, MDA, TNF-α, CRP, IL-6, and IL-8. These results suggest that CTF exerts cardio-protective effects against MIRI via anti-oxidant, anti-inflammatory, and anti-apoptotic activities.

Incidence, correlates, and significance of abnormal cardiac enzyme rises in patients treated with surgical or percutaneous based revascularisation: A substudy from the Synergy between Percutaneous Coronary Interventions with Taxus and Cardiac Surgery (SYNTAX) Trial

AimsThe aim of the present investigation was to determine the long-term prognostic association of post-procedural cardiac enzyme elevation within the randomised Synergy between Percutaneous Coronary Intervention (PCI) with TAXUS and Cardiac Surgery (SYNTAX) Trial. Methods1800 patients with unprotected left main or de novo three-vessel coronary artery disease were randomised to undergo coronary artery bypass graft (CABG) surgery or PCI. Per protocol patients underwent post-procedural blood sampling with creatine kinase (CK), and the cardiac specific MB iso-enzyme (CK-MB) only if the preceding CK ratio was ≥2× the upper limit of normal (ULN). An independent chemistry laboratory evaluated all collected blood samples. ResultsPost-procedural CK sampling was available in 1629 of 1800 patients (90.5%). As per protocol, CK-MB analyses were undertaken in 474 of 491 patients (96.5%) in the CABG arm, and 53 of 61 patients (86.9%) in the PCI arm. Within the CABG arm, despite the limitations of incomplete data, a post-procedural CK-MB ratio <3/≥3 ULN separated 4-year mortality into low- and high-risk groups (2.3% vs. 9.5%, p=0.03). Additionally, in the CABG arm, a post-procedural CK-MB ratio ≥3 ULN was associated with an increased frequency of a high SYNTAX Score (≥33) tertile (high [≥33] SYNTAX Score: 39.5%, intermediate [23–32] SYNTAX Score 31.0%, low [≤22] SYNTAX Score 29.5%, p=0.02). Within the PCI arm, a post-procedural CK ratio of <2 or ≥2 ULN separated 4-year mortality into low- and high-risk groups (10.8% vs. 23.3%, p=0.001). Notably, there was an early (within 6months) and late (after 2years) peak in mortality in patients with a post-PCI CK ratio of ≥2 ULN. Lack of pre-procedural thienopyridine, carotid artery disease, type 1 diabetes, and presence of coronary bifurcations were independent correlates of a CK ratio ≥2 ULN post-PCI. ConclusionCardiac enzyme elevations post-CABG or post-PCI are associated with an adverse long-term mortality; the causes of which are multifactorial.

Risk and Determinants of Myocardial Injury During Off-Pump Coronary Artery Bypass Grafting

Perioperative myocardial injury (PMI) after coronary revascularization (bypass surgery using cardiopulmonary bypass or percutaneous intervention) is strongly associated with future adverse events, such as death, myocardial infarction, and coronary intervention. The incidence, determinants, and prognostic significance of PMI after bypass surgery without cardiopulmonary bypass (off-pump surgery) are unknown. The study population comprised the patients who were randomized to off-pump surgery in the Octopus Study. PMI was defined by a creatine kinase isoenzyme-MB/total creatine kinase ratio of >5% during the first 48 hours, postoperatively. PMI occurred in 137 of 260 patients (52%). Using multivariate regression analysis, age, female gender, previous myocardial infarction, preoperative nitrate use, preoperative diuretic use, and number of grafts were independently associated with an increased risk of PMI during off-pump surgery. The presence of preoperative coronary collaterals showed a negative association with PMI. The occurrence of PMI had a crude odds ratio of 7.53 (95% confidence interval 1.59 to 35.63) for an adverse cardiac event at 1 year after off-pump surgery. This odds ratio changed little after adjustment for confounders (odds ratio 6.39, 95% confidence interval 1.41 to 28.93). In conclusion, more severe atherosclerotic disease and female gender were associated with an increased risk of perioperative myocardial injury during off-pump bypass surgery, although the presence of coronary collaterals appeared to be protective. Patients with perioperative myocardial injury during off-pump surgery were at a higher risk of adverse cardiac outcomes at 1 year.

Striated muscular injury and myocardiac injury caused by acute carbon monoxide poisoning

To investigate the incidence of rhabdomyolysis, the relationship between striated muscular injury and myocardiac injury, and the role of elevated serum creatine kinase (CK) played in screening these two complications following acute carbon monoxide poisoning (ACOP). 280 patients with ACOP from January 2001 to April 2003 were analyzed retrospectively. According to the clinical manifestations of striated muscular injury (swelling, pain or serious myasthenia), the patients were divided into two groups: the evident injury group and non-evident injury group. The abnormality rate of electrocardiogram (ECG) and cardiac troponin I (CTnI) in the evident injury group (43 patients) were significantly higher than in the non-evident injury group (73.8% vs 43.4%, P < 0.001; 77.8% vs 20.9%, P < 0.001). There was a positive correlation between peak CK and MB isoenzyme (CK-MB) in both groups, respectively (r = 0.819, r = 0.795, P < 0.01). There was no correlation in the evident injury group (P > 0.05) and only negative correlation in the non-evident injury group (r = -0.298, P < 0.01) between peak CK and MB ratio (CK-MB/CK). Multiple regression analysis indicated that peak CK and CK-MB were only related with the striated muscular injury and were not affected by the indexes of the myocardial injury (ECG and CTnI); Both peak CK and CK-MB were positively correlated with the coma time before consultation in the non-evident injury group and the latter was also affected by CTnI. The incidence of positive muscular injury symptoms increased with the elevation of CK activity. There was no significant difference either in the ECG abnormality rate between the < 5 times elevated CK level subgroup and the > 5 times elevated CK level subgroup (P > 0.05), or in the CTnI positive rate between the normal CK level subgroup and the < 5 times elevated CK level subgroup (P > 0.05). Striated muscular injury is not a rare complication of ACOP, and always accompanied by myocardial injury. The strikingly elevated serum level of CK in patients with ACOP might be more likely to indicate the striated muscle not myocardiac injury.

The prognostic value of creatine kinase elevations extends across the whole spectrum of acute coronary syndromes

ObjectivesThe study investigated the relationship among creatine kinase (CK) elevations, clinical characteristics and cardiac events across the whole spectrum of acute coronary syndromes (ACS). BackgroundElevated serum levels of cardiac enzymes have been shown to be a major prognostic determinant in acute myocardial ischemia. Yet prior to this report, the relation between cardiac enzyme levels and other prognostic determinants across the entire spectrum of ACS has not been explored by a large clinical study. MethodsWe evaluated the relation between the maximum CK ratio (CK level/upper limit of normal) in the early hours following admission and cardiac events at six months in 11,725 patients enrolled in a large trial of ACS. ResultsPatients with higher risk characteristics, such as older age, female gender, hypertension, diabetes, prior coronary events or heart failure, more frequently presented without ST-segment elevation on the electrocardiogram and tended to develop lesser enzyme elevations. After adjusting for significant baseline predictors of cardiac events, a continuous correlation was observed between the CK ratio and death (chi-square 63.04, p < 0.0001) and (re)infarction or death (chi-square 55.48, p < 0.0001). This correlation was similar for patients with and without ST-segment elevation. The adjusted incidence of cardiac events at follow-up began to rise even for CK levels within the normal range, the steepest part of the curve residing between one and three times the upper limit of normal. In patients with a CK ratio of >1 to 2 compared with those within the normal range, the adjusted odds ratio for death was 1.26 (95% confidence interval [CI] 0.98 to 1.63), and 1.59 (95% CI 1.38 to 1.90) for (re)infarction and death. For all CK levels, the event rate was higher among patients without ST-segment elevation. ConclusionsAlthough high-risk patients with ACS often develop lesser CK elevations, this study demonstrated that even minor enzyme elevations appear to have important and independent prognostic implications.

Myocardial infarction following aortic surgery: a comparison of cardiac troponin I and creatine kinase ratio

Abstract Background Perioperative myocardial infarction may be underdiagnosed and/or misdiagnosed because World Health Organization criteria are often not met and creatinine kinase/creatinine kinase-muscle band (CK/CK-MB) ratios can be difficult to interpret. Cardiac troponin (cTn) I is the most sensitive and specific marker of myocardial cell necrosis but is not yet widely available. The aim was to compare cTnI and CK/CK-MB ratios in the diagnosis of myocardial infarction following aortic surgery. Methods This prospective study included 58 patients undergoing elective (27 aneurysm, seven occlusive) or emergency (24 ruptured aneurysms) aortic surgery. cTnI concentration was measured before operation and 6, 24, 48, 72 and 96 h after surgery. CK and CK-MB levels were measured where cTnI was detectable. Clinical and electrocardiographically detected cardiac events were documented prospectively. Results Conclusion More than half of patients undergoing emergency, and more than a quarter of those undergoing elective, aortic surgery suffer myocardial necrosis as determined by cTnI concentration. This is accompanied by an increased CK/CK-MB ratio in less than one-fifth of cases.

Cardiac troponins and creatine kinase content of striated muscle in common laboratory animals

Animal models are important for the investigation of human heart pathology, novel treatments, and medical or surgical interventions for disease. Serum markers of myocardial damage may also be important tools within this field of research. In order to assess the cardiac specificity of widely utilised serum markers, we measured the cardiac troponins and creatine kinase (CK) isoenzymes in cardiac and skeletal muscle samples taken from dog, monkey, pig and rat. These samples were also analysed by immunoblotting for cardiac troponin I (cTnI) and cardiac troponin T (cTnT). The content of cTnI and cTnT in skeletal muscle was below 0.6% of that found in heart for all animal species studied. This low immunoreactivity in skeletal muscle was confirmed by immunoblot analysis. The content of CK was higher in skeletal muscle than in heart muscle for all species. The CK-MB/total CK ratio was lower in skeletal muscle than in cardiac muscle for all species. The differences in CK-MB content of skeletal muscle and heart muscle were much less pronounced than the tissue differences in the amounts of the cardiac troponins. The cardiac troponins are potentially useful serum markers of myocardial damage, with high specificity for myocardial muscle in these common laboratory animals. Creatine kinase-MB is much less cardiac-specific.

Hypocalcemic Induced Increase in Creatine Kinase in Rats

Calcium plays an important role in various myopathies. We report on an animal model with increased plasma creatine kinase (CK) resulting from hypocalcemia that will provide clues for studying human hypocalcemic myopathy. Male Wistar rats were pair-fed either a control or a calcium- and vitamin D 3-deficient diet for 1, 2, 3, 4, or 5-6 weeks after weaning (3 weeks old). In the deficient diet-fed rats, plasma creatine kinase was increased and was accompanied by marked hypocalcemia. The omission of calcium and vitamin D 3 from the diet for 1 or 2 weeks was enough to cause increased plasma creatine kinase; the creatine kinase ratio of deficient diet-fed rats to controls was 4.84 (1,777 IU L −1/367 IU L −1), and the calcium ion ratio was 0.41 (1.8 mg dL −1/4.4 mg dL −1) after 2 weeks. These values returned to control levels on treatment of the rats with the control diet and 1α-OH-vitamin D 3 for 1 week.