The Annals of Thoracic Surgery, Vol 30, 364-369, Copyright © 1980 by The Society of Thoracic Surgeons
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
GM Graeber, RJ Snyder, R Zajtchuk and WH Brott
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.
