title: Value of serial myoglobin levels in the early diagnosis of patients admitted for acute myocardial infarction.
abstract: OBJECTIVE
  The potential for missing the diagnosis of acute myocardial infarction (AMI) and the need for appropriate use of ICU beds make early and accurate diagnostic tests to assist in this diagnosis valuable. We studied the use of serial myoglobin determinations for patients evaluated in the emergency department and admitted for possible AMI.
  
  
  METHODS
  Over a 3.5-month period, all patients presenting to the ED and admitted for suspected cardiac symptoms had serial cardiac enzymes obtained prospectively at admission and 2, 3, 4, and 6 hours after the onset of symptoms.
  
  
  METHODS
  Large urban community hospital.
  
  
  METHODS
  One hundred thirty-three consecutive patients admitted to treat or rule out AMI.
  
  
  RESULTS
  Twenty-one of 22 patients with an initially normal myoglobin that doubled within 1 to 2 hours after presentation were positive for AMI (specificity, 95%). Sensitivity of myoglobin at 2 hours after the onset of symptoms was 37% and rose to 86% at 6 hours, with 95% specificity. The negative predictive value if myoglobin was normal at 6 hours and had not doubled within 2 hours was 97% (positive predictive value, 88%).
  
  
  CONCLUSIONS
  A repeat myoglobin level that doubled within 1 to 2 hours after the initial value, even if still within the normal range, was highly specific for AMI. Serial myoglobin levels may be useful in earlier identification of AMI to help prevent inappropriate discharge from the ED and for appropriate placement in ICU beds.
authors.affiliation: Department of Emergency Medicine, St Luke's Medical Center, Milwaukee, Wisconsin.
authors.forename: J F
authors.initials: JF
authors.lastname: Tucker
authors.forename: R A
authors.initials: RA
authors.lastname: Collins
authors.forename: A J
authors.initials: AJ
authors.lastname: Anderson
authors.forename: M
authors.initials: M
authors.lastname: Hess
authors.forename: I M
authors.initials: IM
authors.lastname: Farley
authors.forename: D A
authors.initials: DA
authors.lastname: Hagemann
authors.forename: H J
authors.initials: HJ
authors.lastname: Harkins
authors.forename: D
authors.initials: D
authors.lastname: Zwicke
mesh_terms: D000208:Acute Disease; D002637:Chest Pain / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D006801:Humans; D007527:Isoenzymes; D009203:Myocardial Infarction / Q000097:blood*; D009211:Myoglobin / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D007527:Isoenzymes; D009211:Myoglobin; D003402:Creatine Kinase