<原著>急性心筋梗塞の血栓溶解療法と血中creatine kinase遊出動態

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It is well known that the measurement of serum creatine kinase activity (CK) provides a sensitive and specific index for the diagnosis of acute myocardial infarction (AMI), and also that serial determinations of CK can be used to quantify the infarct size. When early reperfusion of the occluded infarct-related coronary artery occurs, however, CK is released earlier and in greater quantities in circulating blood in AMI patients (washout phenomenon), which results in difficulty of the infarct size calculation. The present study was conducted to clarify how the kinetics of serial CK was changed after coronary thrombolysis. In 103 patients who underwent intracoronary thrombolytic therapy (ICT) within 6 hours from the onset of AMI, the author analyzed the relationships between the time components of CK curve and the severity of coronary stenosis after ICT, collateral vessels, wall motion score, using 2D echocardiogram and ECG QRS score. The patients were classified into 5 groups according to the residual coronary stenosis after ICT ; 100% group : complete occlusion (n=19), 99.9% : 99% stenosis with perfusion delay (n=22), 99% : 99% stenosis without the delay (n=15), 90% : 90% stenosis (n=38), 75% : less than 75% stenosis (n=9). The rate of CK release was almost constant in 100% group, while the kinetics of CK was characterized by a higher maximal rate of CK release in the groups with good reperfusion. The pattern of CK release in the groups with severe coronary residual stenosis was similar to that of 100% group. The degree of CK release did not depend upon the collateral vessels. In 100% and 99.9% groups, the total CK release (CKr) closely correlated with the wall motion score (WMS) and QRS score. In 99% groups, there was a significant correlation between CKr and WMS, while the relation between CKr and QRS score was not significant. In 90% and 75% groups, however, CKr did not correlate with WMS and QRS score. Thus, it may be concluded that the coronary reperfusion after ICT in AMI distorted the shape of serial serum CK curve to result in no linear relationship between the infarct size calculated by CK release and left ventricular dysfunction.
近畿大学の論文
1988-03-25

<原著>急性心筋梗塞の血栓溶解療法と血中creatine kinase遊出動態

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