Myoglobin, creatine-kinase-MB and cardiac troponin-I 60-minute ratios predict infarct-related artery patency after thrombolysis for acute myocardial infarction

Abstract

The diagnostic performance of serum myoglobin, CK-MB and cardiac troponin-I (cTnI) 60-min ratios was similar. The probability of a patent IRA was very high (90%) in patients with 60-min myoglobin ratio > or =4.0, and early invasive interventions to establish IRA patency may not be necessary in this group. Serum marker determinations at baseline and 60-min after thrombolysis may permit rapid triage of patients receiving thrombolytic therapy by ruling out IRA occlusion.

Admission Troponin T Level Predicts Clinical Outcomes, TIMI Flow, and Myocardial Tissue Perfusion After Primary Percutaneous Intervention for Acute ST-Segment Elevation Myocardial Infarction

“…14 The usefulness of 60-minute ratios and slopes of myoglobin, CK-MB, and cTnT has been documented in previous studies confirming epicardial patency angiographically. 15,16 In this study, 60-minute ratios and slopes of all cardiac markers were smaller in cTnT-positive patients, suggesting more impaired reperfusion at the tissue level.…”

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes

“…Myoglobin has attracted the most attention for this purpose because of its small molecular size and consequent rapid release (170 -172 ). Rapid washouts of myoglobin, cTnT or cTnI, or CKMB have positive predictive values (PPV) Ͼ90% for infarct artery patency (171)(172)(173)(174). However, a number of factors have limited the clinical application of these findings.…”

“…However, a number of factors have limited the clinical application of these findings. First, absence of biomarker washout appears to overestimate the likelihood of an occluded artery and cannot accurately distinguish slow from normal flow (172,174 ). Second, the logistical challenges of performing multiple measurements in real time have limited use of this strategy.…”

Myoglobin—A marker of reperfusion and a prognostic indicator in patients with acute myocardial infarction

“…This lends further support to our above-mentioned results, indicating that myoglobin could serve as a reliable noninvasive marker for assessing reperfusion. Recently, Tanasijevic et al 23 have also reported the probability of a patent infarct-related artery to be 90% in patients with a 60-min myoglobin ratio ≥ 4. Miyata et al 24 have also shown that the rate of increase in myoglobin was significantly higher in the reperfused than in the nonreperfused group.…”