Serum myoglobin for the early non-invasive detection of coronary reperfusion in patients with acute myocardial infarction.
The ideal non-invasive method for detecting coronary reperfusion has not yet been established. In 63 patients with acute myocardial infarction, serum myoglobin and creatine kinase-MB were measured every 15 min. Thrombolytic treatment was given (n = 52) and acute coronary angiography showed a patent infarct-related artery in 49 patients while 14 patients had no coronary reperfusion. Median time to peak serum myoglobin was shorter (reperfusion group 178 min vs no reperfusion group 480 min, P < 0.0001) than time to peak serum creatine kinase-MB (reperfusion group 550 min vs no reperfusion group 1080 min, P < 0.0001), P < 0.0001. Myoglobin appearance rate, calculated as the concentration at 2 h divided by baseline values (Mb2/Mb0) was highest in the reperfusion group (4.0 vs 1.6), P < 0.001. An earlier proposed index, Mb2/Mb0 > 2.4 for identification of reperfusion 2 h after thrombolytic therapy, showed predictive values of positive and negative tests of 0.94 and 0.44, respectively. Combining this index with signs of medium to larger infarct size (Mb2 > 200 micrograms.l-1) increased the predictive value of the negative test to 1.00. In patients with signs of minor infarcts (Mb2 < 200 micrograms.l-1) the predictive values of positive and negative tests were 0.94 and 0.79, respectively, 5 h after onset of thrombolytic therapy. An early rise and a peak in serum myoglobin values seems to be a reliable and simple non-invasive indicator of successful and unsuccessful reperfusion therapy.
Jurlander
B
B
Department of Medicine B, Heart Center, Rigshospitalet National University Hospital, Denmark.
Clemmensen
P
P
Ohman
E M
EM
Christenson
R
R
Wagner
G S
GS
Grande
P
P
D000328:Adult; D000368:Aged; D015415:Biomarkers; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy*; D015425:Myocardial Reperfusion; D009211:Myoglobin / Q000097:blood*; D011237:Predictive Value of Tests; D015912:Thrombolytic Therapy
D015415:Biomarkers; D007527:Isoenzymes; D009211:Myoglobin; D003402:Creatine Kinase