Diagnostic Efficacy of Cardiac Isoenzyme Ck-mb in Pericardial Fluid for Postmortem Diagnosis of Myocardial Infarction

Sudden cardiac death due to acute myocardial infarction is the most prevalent cause of death in adults and constitutes a significant portion of the autopsies that are conducted by Forensic pathologists in our country. Serum cardiac isoenzymes creatine phosphokinase-MB (CK-MB) has high sensitivity and specificity for cardiac damage and it is routinely used for clinical diagnosis of myocardial infarction (MI). However, in forensic medicine, diagnostic utility of this cardiac marker for postmortem diagnosis of MI has not been fully established. Hence, present study is carried out with aim to evaluate the diagnostic efficacy of CK-MB in pericardial fluid for autopsy diagnosis of MI. The present study included 119 medico-legal autopsy cases selected during a period of 2 years. Four study groups were formed depending upon final cause of death as follows: (1) Sudden cardiac death due to Ischemic heart disease (IHD) (n= 52), (2) violent asphyxia (n=24); (3) Polytraumatic deaths (n=20); (4) natural deaths excluding cardiac causes (n=23).Biochemical analysis of pericardial fluid was carried out. Highest levels of CK-MB were noted in deaths due to IHD. By using this cardiac marker, early infarcts can be predicted in sudden cardiac deaths associated with severe coronary artery disease & inconclusive histopathological findings. We obtained high diagnostic sensitivity and negative predictive value of CK-MB for autopsy diagnosis of MI in pericardial fluid comparable to the clinical analyses on serum.