Two radioimmunoassays compared with isoenzyme electrophoresis for the detection of serum creatine kinase-MB in acute myocardial infarction.

We have evaluated two commercial radioimmunoassay (RIA) reagent kits for the estimation of the MB isoenzyme of creating kinase (CK). Although both methods use CK-B antisera and radioiodinated CK-B, one ("M" for Mallinckrodt) uses hybridized CK-MB for calibration, while the other ("NMS" for Nuclear Medical Systems) uses CK-B. Both assays provide adequate sensitivity, precision, and specificity for the estimation of serum CK-MB. Ninety-nine patients admitted consecutively to our coronary care unit were studied. Apparent CK-MB was measured by both RIAs and results compared with CK-MB enzymatic activity after electrophoresis (E). CK-MB was elevated, as judged by E and by M, in all of 42 patients with acute myocardial infarction (AMI), and in 40 of the 42 by NMS. Of the 57 patients who did not have an AMI, eight had elevated CK-MB by E, 16 by M, and 25 by NMS. Patients with persistently elevated apparent CK-MB concentrations not associated with AMI were identified by M and by NMS, but not by E. The ability to differentiate AMI from no infarction in patients was best with E, and was not satisfactory by NMS. Although the detection of AMI by M equaled that by E, the large number of apparent false-positive results hindered the clinical application of RIA CK-MB measurements.