Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1990 Jun;63(6):335–338. doi: 10.1136/hrt.63.6.335

Early detection of acute myocardial infarction: additional diagnostic information from serum concentrations of myoglobin in patients without ST elevation.

E M Ohman 1, C Casey 1, J R Bengtson 1, D Pryor 1, W Tormey 1, J H Horgan 1
PMCID: PMC1024516  PMID: 2375893

Abstract

The value of the 12 lead electrocardiogram, serum total creatine kinase, creatine kinase MB isoenzyme, and myoglobin for the early detection of infarction was evaluated within one hour of admission to the coronary care unit in 82 consecutive patients with suspected myocardial infarction. The 51 patients in whom infarction was diagnosed during the first 24 hours after admission had a higher prevalence of ST elevation (64% v 11%), higher median serum myoglobin (136 micrograms/l v 34 micrograms/l), higher serum creatine kinase (77 IU/l v 34 IU/l), and higher MB isoenzyme (7 IU/l v 4 IU/l) than those in whom it was not. Stepwise logistic regression analysis in 70 patients in whom the electrocardiogram and serum myoglobin were suitable for analysis showed that serum myoglobin was the variable most closely associated with infarction, and contributed additional diagnostic information when ST elevation was entered into the model first. Serum myoglobin remained associated with myocardial infarction when patients who had had symptoms for less than six hours were analysed. An algorithm based on a rapid agglutination test for myoglobin and ST elevation on the electrocardiogram gave an accurate diagnosis in 82% of patients. This approach gave early and rapid recognition of acute myocardial infarction and warrants further examination.

Full text

PDF
335

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bar F. W., Vermeer F., de Zwaan C., Ramentol M., Braat S., Simoons M. L., Hermens W. T., van der Laarse A., Verheugt F. W., Krauss X. H. Value of admission electrocardiogram in predicting outcome of thrombolytic therapy in acute myocardial infarction. A randomized trial conducted by The Netherlands Interuniversity Cardiology Institute. Am J Cardiol. 1987 Jan 1;59(1):6–13. doi: 10.1016/s0002-9149(87)80060-7. [DOI] [PubMed] [Google Scholar]
  2. Blanke H., Cohen M., Schlueter G. U., Karsch K. R., Rentrop K. P. Electrocardiographic and coronary arteriographic correlations during acute myocardial infarction. Am J Cardiol. 1984 Aug 1;54(3):249–255. doi: 10.1016/0002-9149(84)90176-0. [DOI] [PubMed] [Google Scholar]
  3. Chapelle J. P., Heusghem C. Semi-quantitative estimation of serum myoglobin by a rapid latex agglutination method: an emergency screening test for acute myocardial infarction. Clin Chim Acta. 1985 Jan 30;145(2):143–150. doi: 10.1016/0009-8981(85)90281-5. [DOI] [PubMed] [Google Scholar]
  4. Freeman A. P., Fatches K. R., Carter I. W., Cloonan M. J., Wilcken D. E. Comparison of serum myoglobin and creatine kinase MB isoenzyme in early diagnosis of acute myocardial infarction. Br Heart J. 1981 Apr;45(4):389–392. doi: 10.1136/hrt.45.4.389. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Kubasik N. P., Guiney W., Warren K., D'Souza J. P., Sine H. E., Brody B. B. Radioimmunoassay of serum myoglobin: evaluation and modification of a commercial kit and assessment of its usefulness for detecting acute myocardial infarction. Clin Chem. 1978 Nov;24(11):2047–2049. [PubMed] [Google Scholar]
  6. Lee T. H., Weisberg M. C., Brand D. A., Rouan G. W., Goldman L. Candidates for thrombolysis among emergency room patients with acute chest pain. Potential true- and false-positive rates. Ann Intern Med. 1989 Jun 15;110(12):957–962. doi: 10.7326/0003-4819-110-12-957. [DOI] [PubMed] [Google Scholar]
  7. Miller D. H., Kligfield P., Schreiber T. L., Borer J. S. Relationship of prior myocardial infarction to false-positive electrocardiographic diagnosis of acute injury in patients with chest pain. Arch Intern Med. 1987 Feb;147(2):257–261. [PubMed] [Google Scholar]
  8. Murray N., Lyons J., Layton C., Balcon R. What proportion of patients with myocardial infarction are suitable for thrombolysis? Br Heart J. 1987 Feb;57(2):144–147. doi: 10.1136/hrt.57.2.144. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Nørregaard-Hansen K., Hangaard J., Nørgaard-Pedersen B. A rapid latex agglutination test for detection of elevated levels of myoglobin in serum and its value in the early diagnosis of acute myocardial infarction. Scand J Clin Lab Invest. 1984 Apr;44(2):99–103. doi: 10.3109/00365518409161389. [DOI] [PubMed] [Google Scholar]
  10. Nørregaard-Hansen K., Lindø K. E., Vind Ludvigsen C., Nørgaard-Pedersen B. Serum myoglobin compared with creatine kinase in patients with acute myocardial infarction. Acta Med Scand. 1980;207(4):265–270. doi: 10.1111/j.0954-6820.1980.tb09719.x. [DOI] [PubMed] [Google Scholar]
  11. Rude R. E., Poole W. K., Muller J. E., Turi Z., Rutherford J., Parker C., Roberts R., Raabe D. S., Jr, Gold H. K., Stone P. H. Electrocardiographic and clinical criteria for recognition of acute myocardial infarction based on analysis of 3,697 patients. Am J Cardiol. 1983 Nov 1;52(8):936–942. doi: 10.1016/0002-9149(83)90508-8. [DOI] [PubMed] [Google Scholar]
  12. Sederholm M., Sylvén C. Relation between ST and QRS vector changes and myoglobin release in acute myocardial infarction. Cardiovasc Res. 1983 Oct;17(10):589–594. doi: 10.1093/cvr/17.10.589. [DOI] [PubMed] [Google Scholar]
  13. Short D. The earliest electrocardiographic evidence of myocardial infarction. Br Heart J. 1970 Jan;32(1):6–15. doi: 10.1136/hrt.32.1.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Stone M. J., Willerson J. T. Myoglobinemia in myocardial infarction. Int J Cardiol. 1983 Aug;4(1):49–52. doi: 10.1016/0167-5273(83)90213-9. [DOI] [PubMed] [Google Scholar]
  15. Sylvén C., Bendz R. Myoglobin, creatine kinase and its isoenzyme MB in serum after acute myocardial infarction. Eur J Cardiol. 1978 Nov;8(4-5):515–521. [PubMed] [Google Scholar]
  16. Yusuf S., Pearson M., Sterry H., Parish S., Ramsdale D., Rossi P., Sleight P. The entry ECG in the early diagnosis and prognostic stratification of patients with suspected acute myocardial infarction. Eur Heart J. 1984 Sep;5(9):690–696. doi: 10.1093/oxfordjournals.eurheartj.a061728. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES