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Ann Thorac Surg 1980;30:364-369
© 1980 The Society of Thoracic Surgeons

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Articles

A Comparison of Serum Isoenzyme Levels of Creatine Phosphokinase and Lactic Dehydrogenase in Patients Undergoing Thoracic Operations and Patients Admitted to a Coronary Care Unit

From the Division of Surgery, Walter Reed Army Institute of Research, and the Thoracic Surgery Service, Walter Reed Army Medical Center, Washington, DC, and the Department of Surgery, the Uniformed Services University of the Health Sciences, Bethesda, MD

^* Address reprint requests to Dr. Graeber, Division of Surgery, Walter Reed Army Institute of Research, Walter Reed Army Medical Center, Washington, DC 20012

A prospective study comparing patients undergoing major thoracic surgical procedures with patients admitted to a coronary care unit was conducted. Surgical patients having bronchoscopy and mediastinoscopy (n = 12), anterior thoracotomy (n = 12), and posterolateral thoracotomy (n = 22) were compared with patients in the coronary care unit who had electrocardiographically proved myocardial infarctions (MI) (n = 11) and those with no electrocardiographic abnormalities (n = 12).

Sera were studied by spectrophotometric analysis (creatine phosphokinase [CPK] and lactic dehydrogenase [LDH]), agarose gel electrophoresis (CPK and LDH), and antibody inhibition spectrophotometric analysis (CPK). The levels of total CPK did not rise above the upper limits of normal (100 IU/L) in patients who underwent bronchoscopy and mediastinoscopy. Total CPK elevations in patients undergoing thoracotomy (anterior thoracotomy, 428 ± 62 IU/L [mean ± standard error of the mean]; posterolateral thoracotomy, 652 ± 78 IU/L) were not significantly different from those sustaining acute MIs (463 ± 84 IU/L). Only transient minimal elevations of CPK-MB isoenzyme were noted, however, in the patients having posterolateral thoracotomy (25 ± 7 IU/L). These were significantly lower (p < 0.001) than the elevations seen in patients sustaining acute MIs (80 ± 16 IU/L). In none of the surgical patients did LDH₁ exceed LDH₂ while all of the patients with MIs had such a shift (p < 0.001). The data support the conclusion that the serum isoenzymes of CPK and LDH are capable of confirming the diagnosis of MI in patients recovering from major thoracic surgical procedures.

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