Kosuge M, Kimura K, Nemoto T, Shimizu T, Mochida Y, Nakao M, Hibi K, Sugiyama M, Ishikawa T, Kuji N
Critical Care and Emergency Medical Center, Yokohama City University School of Medicine.
J Cardiol. 1995 Jul;26(1):1-6.
Generally, the time from the onset of acute myocardial infarction (MI) to peak serum creatine kinase (CK) activity is short in patients with acute MI after successful reperfusion. However, in some patients peak CK is observed more than 16 hours after the onset of acute MI despite successful reperfusion. To elucidate the clinical characteristics of patients with late peak CK, CK activity was examined in 55 patients (mean age: 57.5 +/- 10.2 years) with initial acute anterior MI after successful reperfusion. All patients had coronary reflow (TIMI grade 3) within 6 hours after onset of acute MI and no subsequent reocclusion for at least 14 days. The patients were classified into two groups: group E, 41 patients with peak CK observed within 16 hours of onset of acute MI (mean 8.7 hours), and group L, 14 patients with peak CK observed after more than 16 hours (mean 18.7 hours). Although there were no significant differences in the time elapsed between the two groups, the mean peak CK was significantly lower in group L than in group E (2,179 +/- 861 vs 5,379 +/- 2,569 mU/ml, p < 0.01). Well-developed collateral supplies to the infarcted area before reperfusion were observed more frequently in group L (79% vs 24%, p < 0.01). The sum of ST elevation in all leads before reperfusion was lower in group L (12 +/- 7 vs 20 +/- 12 mm, p < 0.01) and additional ST elevation during reperfusion was not observed in group L (0% vs 56%, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
一般来说，急性心肌梗死（MI）成功再灌注后的患者，从急性MI发作到血清肌酸激酶（CK）活性达到峰值的时间较短。然而，在一些患者中，尽管成功再灌注，但在急性MI发作后16小时以上仍观察到CK峰值。为了阐明CK峰值出现较晚的患者的临床特征，我们对55例（平均年龄：57.5±10.2岁）成功再灌注后最初发生急性前壁MI的患者进行了CK活性检查。所有患者在急性MI发作后6小时内实现冠状动脉再通（TIMI 3级），且至少14天内无后续再闭塞。患者分为两组：E组，41例在急性MI发作后16小时内观察到CK峰值（平均8.7小时）；L组，14例在16小时以上观察到CK峰值（平均18.7小时）。尽管两组之间的时间间隔无显著差异，但L组的平均CK峰值显著低于E组（2179±861 vs 5379±2569 mU/ml，p<0.01）。L组再灌注前梗死区域的侧支循环更发达（79% vs 24%，p<0.01）。L组再灌注前所有导联ST段抬高总和较低（12±7 vs 20±12 mm，p<0.01），且L组再灌注期间未观察到额外的ST段抬高（0% vs 56%，p<0.01）。（摘要截断于250字）
