Myoglobin (Mb) is a protein that enters rapidly and is rapidly cleared from plasma after coronary reperfusion. We sought to determine the accuracy with which a rapid rise in plasma [Mb] could predict successful coronary artery reopening in patients undergoing coronary arteriography in conjunction with attempted reperfusion in acute myocardial infarction. In 42 patients, plasma Mb levels were measured before and for at least 4 hours after attempted reperfusion. Thirty-five patients were successfully reperfused. In each, the plasma Mb level rose rapidly with peak [Mb] occurring at 111±8.1 (±SEM) minutes after application of therapy. In contrast, Mb levels rose more slowly in the seven patients who were not reperfused, with peak[Mb] occurring 360±61.4 minutes after attempted reperfusion. T25-100 (the time required for[Mb] to rise from 25% to 100% of peak value) was shorter in patients successfully reperfused (71±7.9 minutes) and longer (341±35.3 minutes) in patients in whom therapy was unsuccessful. A rapid rise in [Mb] after successful reperfusion was also evident by a more than 4.6-fold rise in [Mb] over the first 2 hours after reperfusion in all but five patients; in contrast, [Mb] rose by less than 4.6-fold over this same interval in every patient not successfully reperfused (sensitivity, 85%; specificity, 100%; predictive accuracy, 88%). We conclude that a rapid rise in plasma Mb level over the initial 2 hours after attempted reperfusion in acute myocardial infarction provides a useful index of successful reperfusion. (Circulation 1988;78:1352-1357 W ith the increased use of thrombolytic therapy early in the course of acute myocardial infarction, there is increasing need to determine in individual patients whether reperfusion has been achieved. Myoglobin (Mb) is an intracardiac protein known to be rapidly released into blood after the onset of coronary reperfusion. 1 Because it is also rapidly cleared from the circulation, with a half-time of disappearance of less than 10 minutes,2 Mb concentration-time curves appear to reflect patterns of protein entry into the circulation.This study examines the usefulness of blood myoglobin level determinations in patients undergoing attempted coronary reperfusion early in the

Myoglobin is an intracardiac protein that is released into the blood after myocardial injury and is then cleared rapidly by the kidneys. This study was undertaken to determine whether successful reperfusion of damaged myocardium could be assessed by examination of blood myoglobin concentration-time patterns. After release of a 2 hr occlusion of the mid left anterior descending coronary artery in 11 dogs that had been instrumented over the long term, immunoreactive arterial plasma concentration of myoglobin, [Mb], rose rapidly to a peak within 25 + 2(SEM) min (range 20 to 40). Individual peaks were three to 165 times the myoglobin levels immediately before release of the occlusion. Myoglobin was cleared rapidly from plasma, falling to one-half its peak level 38 3 min after the peak. Similarly well-defined peaks in [Mb] were evident in plasma from the great cardiac vein (GCV), with a mean time to peak of 16 + 2 min and a magnitude of two to 177 times prerelease values. In contrast, arterial and GCV creatine kinase activity-time curves showed less defined peaks and they occurred later and with more variability (60 to 330 min after reperfusion). In nine patients with acute infarction, successful coronary artery reopening was also accompanied by a sharp four-to sixteenfold rise in plasma [Mb] within 1 to 2 hr. Elevations in plasma creatine kinase were slower and more prolonged, peaking at 2 to 18 hr. The sharp, early peaks in [Mb] after successful reperfusion were in contrast to the case in one patient in whom reperfusion was not successful and in whom there was only a gradual increase in [Mb]. T2o100 defined as the time required for [Mb] to rise from 25% to 100% of peak, averaged 48 + 9 min for the nine patients undergoing successful reperfusion. In contrast, T25-100 in published series of patients with acute infarction in whom reperfusion was not attempted averaged 5 to 6 hr. In summary, reperfusion of injured myocardium results in a rapid release of myoglobin into the blood in both experimental animals and man. An early peak in the myoglobin concentration-time curve appears to be an additional useful indicator of reopening of the vessel when reperfusion is undertaken and a coronary arteriogram is not available. Circulation 72, No. 3, 639-647, 1985. IT IS NOW generally agreed that most transmural myocardial infarctions are associated with fresh thrombi superimposed on atherosclerotic lesions of varying severity.' Although the thrombi can often be dissolved with lytic agents, it is frequently difficult to assess whether or not reperfusion has occurred if an immediate coronary arteriographic examination is not performed. Some authors have attempted to use the rate of rise, peak magnitude, and/or time to peak creatine kinase (CK) elevation after reperfusion, but there

SUMMARYIn this prospective randomized trial we explored the possibility of different procedural outcomes with regard to compliant (polyolefin copolymer (POC)), and non-compliant (polyethylene terapthelate (PET)) balloon materials commonly used during percutaneous transluminal coronary angioplasty (PTCA).For this purpose, 51 female and 149 male (total 200) patients were randomized to 100 compliant and 100 non-compliant balloons. Only single lesions were included in the study and patients who had PTCA for more than one lesion in different segments at different sessions were each entered seperately (there were actually 49 female and 143 male patients). PTCA procedures were performed in conjuction with quantitative coronary angiographic techniques and the films were reviewed by two investigators in a blinded fashion. Statistical analysis for various procedural end-points were performed by non-paired Student t test with statistical significance being p < 0.05.There were no differences in demographic and clinical characteristics between groups. Lesion characteristics of both groups were exactly matching for vessel size, balloon size, balloon vessel ratio, minimal luminal diameter and percent stenosis of the index lesion.Similarly, minimal residual diameter, percent residual stenosis, net gain, densitometric net area gain, and maximum pressure (2.2 ± 5 mm vs 2.1 ± 0.6 mm, 18± 17% vs 23± 15%, 0.8±0.5 mm vs 0.8±0.6 mm, 48±25% vs 48 ± 26%, 7.3 ± 2 atm. vs 6.8 ± 3 atm., respectively) values were not statistically different between compliant and non-compliant ballon groups.Major in-hospital complications, dissections caused by the study balloon (mostly type A and B), crossover and bail-out procedures (5 vs 3, 34 vs 32, 4 vs 3, 13 vs 14, respectively) were similar for both compliant and non-compliant balloon groups. Study balloon success rate (defined as < 50% residuel stenosis or > 20% net gain in the absence of major in-hospital complications, crossovers From 'Dokuz

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