SERUM MYOGLOBIN FOR THE EARLY NONINVASIVE DETECTION OF CORONARY REPERFUSION IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION

The ideal non-invasive method for detecting coronary reperfusion has n ot yet been established. In 63 patients with acute myocardial infarcti on, serum myoglobin and creatine kinase-MB were measured every 15 min. Thrombolytic treatment was given (n=52) and acute coronary angiograph y showed a patent infarct-related artery in 49 patients while 14 patie nts had no coronary reperfusion. Median lime to peak serum myoglobin w as shorter (reperfusion group 178 min vs no reperfusion group 480 min, P<0.0001) than time to peak serum creatine kinase-MB (reperfusion gro up 550 min vs no reperfusion group 1080 min, P<0.0001), P<00001. Myogl obin appearance rate: calculated as the concentration at 2 h divided b y baseline values (Mb(2)/Mb(0)) was highest in the reperfusion group ( 4.0 vs 1.6), P<0.001. An earlier proposed index, Mb(2)/Mb(0)>2.4 for i dentification of reperfusion 2 h after thrombolytic therapy, showed pr edictive values of positive and negative tests of 0.94 and 0.44, respe ctively. Combining this index with signs of medium to larger infarct s ize (Mb(2)>200 mu g.1(-1))increased the predictive value of the negati ve test to 1.00. In patients with signs of minor infarcts (Mb(2)<200 m u g.1(-1)) the predictive values of positive and negative tests were 0 .94 and 0.79, respectively, 5 h after onset of thrombolytic therapy. A n early rise and a peak in serum myoglobin values seems to be a reliab le and simple non-invasive indicator of successful and unsuccessful re perfusion therapy.