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(Circulation. 1995;92:2079-2086.)
© 1995 American Heart Association, Inc.

Articles

A Study of Biochemical Markers of Reperfusion Early After Thrombolysis for Acute Myocardial Infarction

Presented in part at the 67th Scientific Sessions of the American Heart Association, Dallas, Tex, November 14-17, 1994.

Thierry Laperche, MD; P. Gabriel Steg, MD; Monique Dehoux, PhD; Joëlle Benessiano, PhD; Gilles Grollier, MD; Etienne Aliot, MD; Jean-Marie Mossard, MD; Pierre Aubry, MD; Damien Coisne, MD; Michel Hanssen, MD; Marie-Christine Iliou, MD; for the PERM Study Group

From the Cardiology Departments of Hôpital Beaujon, Clichy (T.L.); Hôpital Bichat, Paris (P.G.S., P.A.); Hôpital Côte de Nacre, Caen (G.G.); Hôpital Central, Nancy (E.A.); Hôpital de Hautepierre, Strasbourg (J-M.M.); Hôpital la Milétrie, Poitiers (D.C.); Clinique Saint Joseph, Colmar (M.H.); Hôpital Broussais, Paris (M-C.I.); and the Biochemistry Department, Hôpital Bichat, Paris (M.D., J.B.), France.

Correspondence to Thierry Laperche, MD, Service de Cardiologie, Hôpital Beaujon, 100 Bd du Général Leclerc, 92118 Clichy Cedex, France.

Background In acute myocardial infarction (AMI), early noninvasive identification of patients with occluded infarct-related arteries (IRAs) after thrombolysis has important prognostic and therapeutic implications. The aims of this study were to evaluate biochemical methods for the early diagnosis of patency after thrombolysis prospectively and to establish the optimal diagnostic criteria retrospectively.

Methods and Results In 97 patients with AMI treated with thrombolytic agents 6 hours after the onset of symptoms, myoglobin, troponin T, creatine kinase, the MB isoenzyme and MM isoforms of creatine kinase were measured just before thrombolysis began and 90 minutes later. IRA patency was assessed by means of 90-minute coronary angiography. For each marker, compared with the expected sensitivity and specificity based on published thresholds for the diagnosis of patency, the observed values were consistently lower but were markedly improved in a subset of patients treated >3 hours after the onset of symptoms. With receiver-operator characteristic curve analysis of the slopes of increase and relative increases in each marker over 90 minutes, the best diagnostic performance was achieved by use of the relative increase in myoglobin, troponin T, and MM3/MM1 creatine kinase isoforms in patients treated >3 hours after onset (areas under the curve of 0.84, 0.83, and 0.85, respectively).

Conclusions Effective early noninvasive diagnosis of patency after thrombolysis is possible in patients treated >3 hours after symptom onset by use of criteria derived from the relative increase over 90 minutes in plasma markers, particularly myoglobin, troponin T, and MM3/MM1 creatine kinase isoforms. The diagnostic performance of the relative increase in myoglobin appears to be less susceptible to small changes in the diagnostic threshold value.

Key Words: myocardial infarction • reperfusion • myoglobin • creatine kinase • troponin T

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