EARLY BEHAVIOR OF BIOCHEMICAL MARKERS IN PATIENTS WITH THROMBOLYSIS IN MYOCARDIAL-INFARCTION GRADE-2 FLOW IN THE INFARCT ARTERY AS OPPOSED TO OTHER FLOW GRADES AFTER INTRAVENOUS THROMBOLYSIS FOR ACUTE MYOCARDIAL-INFARCTION

Background Biochemical markers have been suggested for the noninvasive diagnosis of reperfusion early after thrombolysis. Their ability to d iscriminate between Thrombolysis in Myocardial Infarction (TIMI) 2 and 3 flow grades remains unknown. Methods In 97 patients with myocardial infarction less than or equal to 6 hours, myoglobin, troponin T, MBCK , and MMCK isoforms were measured before thrombolysis and after 90 min utes. A 90-minute coronary angiography ascertained the potency status of the infarct-related artery in all patients according to the TIMI gr ade flow (group A: TIMI 0-1 (n = 35), group B: TIMI 2 (n = 17), and gr oup C: TIMI 3 (n = 45). For each marker the absolute rate of increase and the relative increase 90 minutes after thrombolysis were studied. Results Both absolute values and absolute rates of increase at 90 minu tes of myoglobin were higher in group B than in groups A and C (p < 0. 05, not significant for other markers). Relative increases were consis tently higher in group C than in other groups with statistical signifi cance for myoglobin in the subset of patients treated for >3 hours. Co nclusion Diagnostic indexes based on relative increases tend to discri minate between patients with TIMI 2 and 3 flow, and the best performan ce is obtained when the relative increase of myoglobin at 90 minutes i s used in patients treated later than 3 hours after onset of symptoms.