Evaluation and comparison of immunoinhibition and immunoprecipitation methods for differentiating MB and BB from macro forms of creatine kinase isoenzymes in patients and healthy individuals.

We compared results for measurements of creatine kinase isoenzyme MB (CK-MB) by immunoinhibition vs immunoprecipitation, using sera from 53 normal healthy individuals, 55 patients with increased CK-MB associated with acute myocardial infarction, and 42 patients whose blood exhibited one or more abnormal forms of CK by electrophoresis. These last 42 patients, selected from a group of 91 cases exhibiting abnormal forms as detected in a screening of 5000 hospitalized and clinic patients, include: (a) CK-BB bound to IgG (macro CK type 1), (b) a polymeric complex of mitochondrial CK (macro CK type 2), (c) abnormally high activity of free CK-BB isoenzyme, and (d) persistent increases of CK-MB from patients without myocardial infarction. These abnormal forms occur in less than 2% of all patients and are exceedingly rare in patients with acute myocardial infarction. Therefore, the vast majority of CK-MB analyses can be performed rapidly and efficiently by immunoinhibition, which has analytical sensitivity, is associated with high clinical sensitivity, and is easily automated for a low cost per test. In contrast, immunoprecipitation is a more specific analytical measurement of CK-MB but is less efficient and more costly.