Does lactate dehydrogenase isoenzyme-5 contribute to the predictive power of total lactate dehydrogenase in myocardial infarction?

In 385 patients with acute myocardial infarction, lactate dehydrogenase (LD; EC 1.1.1.27) isoenzymes were determined electrophoretically 24, 48, and 72 h after admission. At those times, LD-1/LD-2 ratios exceeding 1 were recorded in 78.9, 88.8, and 92.2% of the cases, respectively. LD-1 ranged from 181 to 2674 U/L, or 21.9 to 66.1% of the total activity. On the first day of hospitalization, 27.3% of the patients demonstrated abnormal LD-5 (greater than 6% of total LD); this finding dropped to 20.5% and 17.4% in the two following days. Early increases in LD-5 were most frequently observed in patients associating inferior infarcts with posterior or lateral extension and having a previous history of myocardial infarction. On day 1, LD-5 was significantly increased in early deceased patients as compared to long-term survivors (9.7% vs 4.9% of total LD, p less than 0.01). LD-5 definitely contributes to the prognostic efficiency of total LD in acute myocardial infarction, but does not replace it as a risk predictor. This study confirms the superiority of total LD over the isoenzyme measurements to achieve short-term prognostication.