Rj. De Winter et al., Diagnostic accuracy of myoglobin concentration for the early diagnosis of acute myocardial infarction, ANN EMERG M, 35(2), 2000, pp. 113-120
Study objective: We evaluated the diagnostic accuracy of myoglobin determin
ation for the early diagnosis of acute myocardial infarction (AMI).
Methods: Consecutive patients with chest pain were included in the study. R
eceiver operating characteristic (ROC) analysis was used to assess optimal
timing of blood sampling and cutoff values.
Results: A total of 309 patients were included, of whom 162 patients had a
diagnosis of AMI. ROC analysis revealed that the diagnostic accuracy of myo
globin concentration as indicated by the area under the ROC curve (AUC) inc
reased significantly from 3 (0.89+/-0.026) and 4 hours (0.93+/-0.019) to 5
hours after onset of symptoms (0.96+/-0.014; P=.0040 and .035, respectively
). At 5 hours (the earliest time point with maximal AUC), sensitivity was 8
7% and specificity was 97% using a myoglobin cutoff value of 90 mu g/L. Wit
h a myoglobin cutoff value of 50 mu g/L, sensitivity was 95% (95% confidenc
e interval 90% to 98%), but specificity was 86% (95% confidence interval 80
% to 93%).
Conclusion: Myoglobin has maximal diagnostic accuracy for the diagnosis of
AMI at 5 hours after the onset of symptoms, using a cutoff value of 50 mu g
/L. In combination with the measurement of other biochemical markers, myogl
obin determination could be particularly useful for triage of patients with
AMI at an early stage.