Serum myoglobin for the early non-invasive detection of coronary reperfusion in patients with acute myocardial infarction

The ideal non-invasive method for detectmg coronary reperfusionhas not yet been established. In 63 patients with acute myocardialinfarction, serum myoglobin and creatine kinase-MB were measuredevery 15mm. Thrombolytic treatment was given (n=52) and acutecoronary angiography showed a patent infarct-related arteryin 49 patients while 14 patients had no coronary reperfusion.Median time to peak serum myoglobin was shorter (reperfusiongroup 178 mm vs no reperfusion group 480 min, P<0·0001)than time to peak serum creatine kinase-MB (reperfusion group550 mm vs no reperfusion group 1080 min, P<0·0001),P<0·0001. Myoglobin appearance rate, calculated asthe 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 identificationof reperfusion 2 h after thrombolytic therapy, showed predictivevalues of positive and negative tests of 0·94 and 0·44,respectively. Combining this mdex with signs of medium to largerinfarct size (Mb₂>200 µg . 1^–1)increased thepredictive value of the negative test to 1·00. In patientswith signs of minor mfarcts (Mb₂ <200 .µg .1^–1)the predictive values of positive and negative tests were 0·94and 0·79 respectively, 5 h after onset of thrombolytictherapy. An early rise and a peak in serum myoglobin values seems tobe a reliable and simple non-invasive indicator of successfuland unsuccessful reperfusion therapy. (Eur Heart J 1996; 17: 399–406)