Creatine Kinase (CK): Its Use in the Evaluation of Perioperative Infarction

摘要

Evaluation of serum creatine kinase (CK), and specifically its MB coenzyme (CK-MB), has been very useful in establishing the diagnosis of acute myocardial infarction. Some investigators have gone so far as to state that CK-MB is specific for myocardium, and hence the appearance of this coenzyme in the serum is indicative of myocardial damage. Experience with surgical patients has suggested that serum CK-MB bands in the peroperative period could reflect injury to tissues other than myocardium because many patients who had such bands had to clinical or electrocardiographic evidence of acute myocardial infarction. Laboratory investigations conducted over the last decade have helped to refine the interpretation of serum CK in the perioperative period by identifying the advantages and disadvantages of each method used to evaluate this enzyme system, defining its distribution in various tissues, and elucidating clinical conditions that can affect the specific isoenzymes of serum CK. This article will review these clinical and laboratory studies and correlate the data from the various investigations to present a more thorough understanding of the changes in serum CK experienced by patients undergoing surgery, in particular, open heart surgery. Most importantly, it will review the criteria that the investigations have elucidated for establishing the diagnosis of acute perioperative myocardial infarction. (Reprints)