Copyright © 1996 by the European Society of Cardiology.
© 1996 The European Society of Cardiology
Serum myoglobin for the early non-invasive detection of coronary reperfusion in patients with acute myocardial infarction
Department of Medicine B, Heart Center, Rigshospitalet National University Hospital, Denmark, and Department of Medicine, Division of Cardiology, Duke University Medical Center Durham, North Carolina, U.S.A.
Received 6 June 1995; accepted 11 July 1995.
Correspondence:Peer Grande, MD, PhD, Heart Center Rigshospitalet, National University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
Abstract
The ideal non-invasive method for detectmg coronary reperfusion has not yet been established. In 63 patients with acute myocardial infarction, serum myoglobin and creatine kinase-MB were measured every 15mm. 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 mm vs no reperfusion group 480 min, P<0·0001) than time to peak serum creatine kinase-MB (reperfusion group 550 mm 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 mdex with signs of medium to larger infarct size (Mb2>200 µg . 1–1)increased the predictive value of the negative test to 1·00. In patients with signs of minor mfarcts (Mb2 <200 .µg .1–1) 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.
(Eur Heart J 1996; 17: 399–406)
Key Words: Acute myocardial infarction • intravenous thrombolysis • coronary reperfusion • myoglobin • creatine kinase-MB
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