CLINICAL STUDIES
Myoglobin, creatine-kinase-MB and cardiac troponin-I 60-minute ratios predict infarct-related artery patency after thrombolysis for acute myocardial infarction
Results from the thrombolysis in myocardial infarction study (TIMI) 10B
Milenko J. Tanasijevic, MD*,1,
Christopher P. Cannon, MD ,
Elliott M. Antman, MD,
Donald R. Wybenga, MD*,
George A. Fischer, PhD*,
Christine Grudzien*,
C. Michael Gibson, MD ,
James W. Winkelman, MD*,
Eugene Braunwald, MD for the TIMI 10B Investigators
* Clinical Laboratories, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Department of Medicine, VA Medical Center, West Roxbury, Massachusetts, USA
Manuscript received November 6, 1998;
revised manuscript received April 7, 1999,
accepted May 16, 1999.
Reprint requests and correspondence: Dr. Milenko J. Tanasijevic, Clinical Laboratories, Brigham and Women’s Hospital, Amory building, 215 A, 75 Francis Street, Boston, Massachusetts 02115
mtanasijev{at}bics.bwh.harvard.edu
OBJECTIVES
We examined the diagnostic performance of serum myoglobin, creatine-kinase-MB (CK-MB) and cardiac Troponin-I (cTnI) for predicting the infarct-related artery (IRA) patency in patients receiving TNK-tissue plasminogen activator (TNK-tPA) therapy for acute myocardial infarction (AMI) in the Thrombolysis in Myocardial Infarction (TIMI) 10B trial.
BACKGROUND
A reliable noninvasive serum marker of IRA patency is desired to permit early identification of patients with a patent IRA after thrombolysis.
METHODS
We measured myoglobin, CK-MB and cTnI concentrations in sera obtained just before thrombolysis (T0) and 60 min later (T60) in 442 patients given TNK-tPA and who underwent coronary angiography at 60 min.
RESULTS
Angiography at 60 min showed a patent IRA (TIMI flow grade 2, 3) in 344 and occluded IRA (TIMI flow grade 0, 1) in 98 patients. The median serum T60 concentration, the ratio of the T60 and T0 serum concentration (60-min ratio) and the slope of increase over 60 min for each serum marker were significantly higher in patients with patent arteries compared with patients with occluded arteries. The area under the receiver-operating characteristic (ROC) curve for diagnosis of occlusion was 0.71, 0.70 and 0.71 for the 60-min ratio of myoglobin, cTnI and CKMB, respectively. The 60-min ratios of  4.0 for myoglobin, 3.3 for CK-MB and 2.0 for cTnI yielded a probability of patency of 90%, 88% and 87%, respectively.
CONCLUSIONS
The diagnostic performance of serum myoglobin, CK-MB and cardiac Tropinin-I (cTnI) 60-min ratios was similar. The probability of a patent IRA was very high (90%) in patients with 60-min myoglobin ratio 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.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | AUC | = area under the receiver-operating characteristic curve | | CK-MB | = creatine-kinase-MB | | cTnI | = cardiac Troponin-I | | ECG | = electrocardiogram | | IRA | = infarct-related artery | | PTCA | = percutaneous transluminal coronary angioplasty | | ROC | = receiver-operating characteristics | | TIMI | = Thrombolysis in Myocardial Infarction | | TNK-tPA | = TNK-tissue plasminogen activator |
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