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December 12, 1966

Enzyme Activity Tests Halve Missed Myocardial Infarction

JAMA. 1966;198(11):40. doi:10.1001/jama.1966.03110240014005

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Missed diagnoses of myocardial infarction can be halved with increased use of activity tests for two enzymes, a California clinician believes.

"This means we can get to another 10% to 12% of these cases in time to do something about them," Eugene L. Coodley, MD, told JAMAMedical News.

A comparative study of electrocardiogram and blood level changes of four enzymes in 215 patients was reported by Dr. Coodley in cardiopulmonary section exhibit.

Two serum enzymes, hydroxy butyrate dehydrogenase (HBD) and creatine phospho-kinase (CPK ), proved specific indices of infarction.

Also studied were two other enzymes liberated by tissue destruction, serum glutamic oxaloacetic transaminase (SGOT) and serum lactic dehydrogenase (SLDH).

Unlike SGOT, CPK is a more specific product of myocardial necrosis. If muscle disease, brain damage and hypothyroidism are excluded, CPK elevations mean cardiac damage.

An elevation of five times normal CPK can be detected three to six hours post-infarction. This