Myoglobin, creatine kinase MB, and cardiac troponin-I to assess reperfusion after thrombolysis for acute myocardial infarction: Results from TIMI 10A☆,☆☆,★,★★,♢
Section snippets
Study population
The TIMI 10A trial, a phase I, dose-ranging, pilot trial was conducted in the United States between January and November 1995. It evaluated a new thrombolytic agent, TNK-tissue plasminogen activator (TNK-tPA), in patients with AMI, as previously reported. 32 The study patients were between the ages of 19 and 69, had episodes of pain lasting ≥30 minutes and within 12 hours from symptom onset, associated with ST-segment elevation ≥0.1 mV in two or more contiguous electrocardiogram leads, or new
Patient characteristics
Table I summarizes the baseline clinical characteristics of the 27 patients included in the study. There were 21 men and six women with a mean age of 55.6 years. The time interval from the onset of chest pain to start of thrombolytic therapy averaged 3 ± 1.3 hours. In 19 patients (group A), angiography at 60 minutes revealed TIMI flow grade 2 or 3. In the remaining eight patients, the TIMI flow grade was 0 or 1 (group B). Angiography at 60 minutes identified the left anterior descending
Discussion
The aim of this study was to investigate the diagnostic performance of serum myoglobin, CK-MB, and cTnI concentrations obtained 60 minutes after initiation of thrombolysis in assessing the infarct-related artery patency, the most important aspect of early AMI care.41
Our findings indicate that at the diagnostic cutoffs optimized to identify all patients with occluded coronary arteries (i.e., 100% sensitivity for vessel occlusion), a single myoglobin concentration measured 60 minutes from
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*See Appendix.
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Supported by Dade International, Miami, Fla. The TIMI 10A Clinical Centers were supported by Genentech, South San Francisco, Calif.
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Reprint requests: Milenko J. Tanasijevic, MD, Clinical Laboratories, Brigham and Women’s Hospital, Amory Building, 215 A, 75 Francis St., Boston, MA 02115.
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E-mail: [email protected]
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