Assessment of coronary reperfusion after thrombolysis with a model combining myoglobin, creatine kinase-MB, and clinical variables. TAMI-7 Study Group. Thrombolysis and Angioplasty in Myocardial Infarction-7.

Published

Journal Article

BACKGROUND: Several biochemical markers have been investigated for the noninvasive assessment of reperfusion after myocardial infarction. Because myoglobin is released very soon after myocardial injury and clears rapidly after reperfusion, it may prove to be an excellent marker of occlusion and reperfusion. METHODS AND RESULTS: We examined the relation between various myoglobin measures and Thrombolysis In Myocardial Infarction (TIMI) flow grade in 96 patients enrolled in a study of front-loaded thrombolysis who underwent 90-minute angiography. We also combined myoglobin measures with models that include clinical and creatine kinase-MB variables. The myoglobin level measured within 10 minutes of acute angiography showed the best overall performance and was used for later analyses. Of the clinical variables examined, only time from symptom onset to thrombolysis and chest pain grade at angiography discriminated among TIMI flow grades. Combining the 90-minute myoglobin level and these clinical variables showed a significant difference (P<.0001) between both TIMI 3 versus TIMI 0 through 2 and TIMI 2 or 3 versus TIMI 0 or 1 flow. When the 90-minute myoglobin level was added to an established predictive model containing clinical variables and creatine kinase-MB measures, its contribution remained significant (P=.044). The area under the receiver operator characteristic curve for this combined model was .88. CONCLUSIONS: A single myoglobin measurement obtained 90 minutes after the start of thrombolysis, combined with select clinical variables and creatine kinase-MB levels, enhances the noninvasive prediction of reperfusion after myocardial infarction.

Full Text

Duke Authors

Cited Authors

  • Christenson, RH; Ohman, EM; Topol, EJ; Peck, S; Newby, LK; Duh, SH; Kereiakes, DJ; Worley, SJ; Alosozana, GL; Wall, TC; Califf, RM

Published Date

  • September 16, 1997

Published In

Volume / Issue

  • 96 / 6

Start / End Page

  • 1776 - 1782

PubMed ID

  • 9323061

Pubmed Central ID

  • 9323061

International Standard Serial Number (ISSN)

  • 0009-7322

Digital Object Identifier (DOI)

  • 10.1161/01.cir.96.6.1776

Language

  • eng

Conference Location

  • United States