Original contribution
Myoglobin as an early indicator of acute myocardial infarction

https://doi.org/10.1016/S0196-0644(87)80521-8Get rights and content

The ECG and the determination of serum enzymes creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) may be falsely normal early in acute myocardial infarction. Myoglobin, an oxygen-carrying protein found in cardiac muscle and striated skeletal muscle, presents an attractive alternative to CPK and LDH in the emergency department setting for identification of acute myocardial infarction. Myoglobin levels may be elevated in the serum within one hour after myocardial cell death with peak levels reached within four to six hours. We report a study of 59 patients presenting to a community hospital with chest pain and subsequent hospitalization. Twenty-one had an acute myocardial infarction. Presenting (0 hour) myoglobin determination was positive in 13 of 21 individuals, while CPK-MB was positive in only three. Serum myoglobin elevation at three hours identified all 21 patients with myocardial infarction with the CPK-MB determination positive in 19. Serum myoglobin elevation may permit early identification of myocardial infarction, with subsequent verification using CPK-MB determination, allowing appropriate intensive care admission for careful monitoring of these patients.

References (38)

  • MacLennanBA et al.

    High dose intravenous streptokinase in acute myocardial infarction — short and long term prognosis

    Br Heart J

    (1986)
  • A prospective trial of intravenous streptokinase in acute myocardial infarction (ISAM)

    N Engl J Med

    (1986)
  • SteinEA et al.

    Serum enzymes, isoenzymes, myoglobin, and contractile proteins in acute myocardial infarction

  • StoneMJ et al.

    Radioimmunoassay of myoglobin in human serum. Results in patients with myocardial infarction

    J Clin Invest

    (1975)
  • StoneMJ et al.

    Serum myoglobin level as diagnostic test in patients with acute myocardial infarction

    Br Heart J

    (1977)
  • RoxinL-E et al.

    The value of serum myoglobin determinations in the early diagnosis of acute myocardial infarction

    Acta Med Scand

    (1984)
  • McCombJM et al.

    Myoglobin in the very early phase of acute myocardial infarction

    Ann Clin Biochem

    (1985)
  • FreemanAP et al.

    Comparison of serum myoglobin and creatine kinase MB isoenzyme in early diagnosis of acute myocardial infarction

    Br Heart J

    (1981)
  • WitherspoonLR et al.

    Assessment of serum myoglobin as a marker for acute myocardial infarction

    J Nuc Med

    (1979)
  • Cited by (111)

    • Cardiac markers of myocardial necrosis. A history and discussion of milestones and emerging new trends

      2014, Clinics in Laboratory Medicine
      Citation Excerpt :

      Because of its kinetic pattern of release, myoglobin was used in the 1990s and early 2000s as an early marker of myocardial necrosis. In an early study, myoglobin testing at admission to the emergency department detected 57% of myocardial infarctions and testing at 3 hours after admission permitted detection of 100% of cases.6 Myoglobin was particularly helpful when used in conjunction with other more specific cardiac markers (eg, CK-MB and troponin) in multimarker panels, and accelerated rule-out myocardial infarction protocols (discussed later).

    • Takotsubo cardiomyopathy has a unique cardiac biomarker profile: NT-proBNP/myoglobin and NT-proBNP/troponin T ratios for the differential diagnosis of acute coronary syndromes and stress induced cardiomyopathy

      2012, International Journal of Cardiology
      Citation Excerpt :

      However, NT-proBNP/myoglobin ratio has a sensitivity of 89% at a specificity of 90% for discrimination of TC from STEMI and a sensitivity of 65% at a specificity of 90% to distinguish TC from NSTEMI. In this context, it is important to be aware that myoglobin levels will peak approximately 2 to 6 h after onset of pain [13, 14]. Of note, to distinguish acute coronary syndromes from Takotsubo at the highest specificity and sensitivity, the use of the peak NT-proBNP/peak TnT ratio appeared most accurate.

    View all citing articles on Scopus

    This work was supported in part by the Proctor & Gamble Company, Cincinnati, Ohio.

    Presented at the American College of Emergency Physicians, Scientific Assembly, Atlanta, September 1986.

    View full text