Immunochemical extraction and automated measurement of plasma creatine kinase MB isoenzyme and creatine kinase MB2 isoform.

Measurement of creatine kinase MB (CK-MB) and its isoforms CK-MB2 and CK-MB1 are now applied in the diagnosis of acute myocardial infarction (AMI). The most common approach for analysis includes RIA, IRMA, and electrophoresis, all of which may be time-consuming. This study examines determination of CK-MB and CK-MB2 by a rapid immunochemical extraction method followed by an automated measurement for both analytes. The automated method was sensitive to 2 U/L, linear to 180 U/L, and gave excellent interassay precision (< 10% CV). Interference studies indicated that bilirubin, hemolysis, and lipemia caused analytical problems as did the presence of high activities of other CK isoenzymes, notably CK-MM and CK-BB, requiring dilution of samples prior to analysis. Application of immunochemical extraction gave a reference interval of CK-MB (0-2.5 U/L) and CK-MB2 (0.1-1.4 U/L) for blood donors (20-60 years), peak levels for ruled-out AMI patients of CK-MB (0.5-7.3 U/L) and CK-MB2 (0.3-4.9), peak levels for ruled-in AMI patients of CK-MB (80-174 U/L) and CK-MB2 (80-155 U/L). Coronary artery bypass patients (n = 24) and all trauma patients (n = 14) also demonstrated elevations in CK-MB and CK-MB2, whereas only five of the trauma patients demonstrated increased CK-MB by IRMA. In patients (n = 7) having increased total CK and normal CK-MB by IRMA, the extraction assay for CK-MB and CK-MB2 yielded increased values in all patients. This new approach to CK-MB and CK-MB2 analysis can be performed within 30 minutes of sample receipt.