title: Serum myoglobin/carbonic anhydrase III ratio as a marker of reperfusion after myocardial infarction.
abstract: BACKGROUND
  Coronary patency is important for short- and long-term outcome after myocardial infarction. Serum myoglobin concentration is a sensitive marker of myocardial damage and its specificity can be improved by simultaneous measurement of carbonic anhydrase III, a skeletal muscle marker. In the present study we evaluated the role of myoglobin/carbonic anhydrase III ratio as a non-invasive marker of reperfusion.
  
  
  METHODS
  We measured myoglobin, carbonic anhydrase III and creatine kinase MB-fraction release serially in 29 patients with acute myocardial infarction treated with thrombolysis and in 28 patients treated with primary coronary angioplasty.
  
  
  RESULTS
  Thrombolytic therapy was followed by a 9.1+/-2.2-fold increase in myoglobin and 10.8+/-3.3-fold increase in creatine kinase MB-fraction during the first hour of treatment, while carbonic anhydrase III remained unchanged. The peak value of myoglobin/carbonic anhydrase III ratio was found at 2 h and that of creatine kinase MB-fraction at 8 h after thrombolysis. Knowledge of the reperfusion time point during primary angioplasty and follow-up of cardiac markers revealed that cut-off points of 3 and 10 h for the peak values of myoglobin/carbonic anhydrase III ratio and creatine kinase MB-fraction can be used as indicators for reperfusion, respectively. Myoglobin/carbonic anhydrase III ratio measured before treatment and at 2 and 4 h after the onset of treatment screened 23 of those 25 patients with probable reperfusion after thrombolysis.
  
  
  CONCLUSIONS
  We conclude that measuring myoglobin/carbonic anhydrase III ratio during the first hours after initiation of thrombolysis may be useful in evaluating the success of reperfusion after acute myocardial infarction.
authors.affiliation: Department of Internal Medicine, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Vuotikka
authors.forename: Paavo
authors.initials: P
authors.lastname: Uusimaa
authors.forename: Matti
authors.initials: M
authors.lastname: Niemelä
authors.forename: Kalervo
authors.initials: K
authors.lastname: Väänänen
authors.forename: Juhani
authors.initials: J
authors.lastname: Vuori
authors.forename: Keijo
authors.initials: K
authors.lastname: Peuhkurinen
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D024403:Carbonic Anhydrase III / Q000097:blood* / Q000187:drug effects; D003324:Coronary Artery Disease / Q000097:blood / Q000628:therapy; D003402:Creatine Kinase / Q000097:blood / Q000187:drug effects; D052279:Creatine Kinase, MB Form; D004636:Emergency Service, Hospital; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D007527:Isoenzymes / Q000097:blood / Q000187:drug effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000628:therapy*; D015425:Myocardial Reperfusion; D009211:Myoglobin / Q000097:blood* / Q000187:drug effects; D010343:Patient Admission; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D011237:Predictive Value of Tests; D012086:Reoperation; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D005343:Fibrinolytic Agents; D007527:Isoenzymes; D009211:Myoglobin; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D013300:Streptokinase; D010959:Tissue Plasminogen Activator; D024403:Carbonic Anhydrase III