Myoglobin levels at 12 hours identify patients at low risk for 30-day mortality after thrombolysis in acute myocardial infarction

A Thrombolysis in Myocardial Infarction 10B substudy

V. S. Srinivas, Christopher P. Cannon, C. Michael Gibson, Elliott M. Antman, Mark A. Greenberg, Milenko J. Tanasijevic, Sabina Murphy, James A. De Lemos, Seth Sokol, Eugene Braunwald, Hiltrud S. Mueller

Research output: Contribution to journalArticle

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Abstract

Objective: We sought to identify, by use of serum cardiac markers, patients at low risk for 30-day mortality after ST-segment elevation myocardial infarction. Background: Baseline cardiac markers are currently used to identify patients at increased risk for short-term events. We hypothesized that serum markers measured after treatment could identify patients at low risk for 30-day mortality. Methods: A total of 839 patients from the Thrombolysis in Myocardial Infarction (TIMI) 10B study had myoglobin, cardiac-specific troponin-I, creatine kinase (CK)-MB measurements at the following time points; baseline, 90 minutes, and 3 and 12 hours after thrombolysis. By use of receiver operating characteristic analysis, thresholds were derived to predict 30-day mortality with at least 95% negative predictive value. Results: Ninety minutes after thrombolysis myoglobin was superior to troponin-I or CK-MB in identifying patients at low risk for mortality. The 30-day mortality for 12-hour myoglobin ≤239 ng/mL was 1.4% compared with 9.1% for levels >239 ng/mL (P < .001). For 12-hour troponin-I (threshold 81.5 ng/mL), mortality was 1.9% versus 6.6% (P = .001) if above threshold; similarly for CK-MB at 12 hours (threshold 191 ng/mL) it was 3.3% versus 7.9% (P = .02). Multivariate analysis of baseline and posttreatment cardiac markers, age, sex, infarct artery location, and 90-minute TIMI flow grade identified only 12-hour myoglobin among the cardiac markers as independently predicting a low 30-day mortality (odds ratio 0.11, 95% confidence interval 0.02-0.50, P < .004). Conclusion: Serum cardiac markers can identify greater than two thirds of patients at low risk for 30-day mortality. A low 12-hour myoglobin level (≤239 ng/mL in this substudy) identifies such patients at low risk and could potentially assist in early risk stratification and triage after ST-segment elevation myocardial infarction.

Original languageEnglish (US)
Pages (from-to)29-36
Number of pages8
JournalAmerican Heart Journal
Volume142
Issue number1
DOIs
StatePublished - 2001

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Myoglobin
Myocardial Infarction
Mortality
MB Form Creatine Kinase
Troponin I
Biomarkers
Triage
ROC Curve
Multivariate Analysis
Arteries
Odds Ratio
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Myoglobin levels at 12 hours identify patients at low risk for 30-day mortality after thrombolysis in acute myocardial infarction : A Thrombolysis in Myocardial Infarction 10B substudy. / Srinivas, V. S.; Cannon, Christopher P.; Gibson, C. Michael; Antman, Elliott M.; Greenberg, Mark A.; Tanasijevic, Milenko J.; Murphy, Sabina; De Lemos, James A.; Sokol, Seth; Braunwald, Eugene; Mueller, Hiltrud S.

In: American Heart Journal, Vol. 142, No. 1, 2001, p. 29-36.

Research output: Contribution to journalArticle

Srinivas, V. S. ; Cannon, Christopher P. ; Gibson, C. Michael ; Antman, Elliott M. ; Greenberg, Mark A. ; Tanasijevic, Milenko J. ; Murphy, Sabina ; De Lemos, James A. ; Sokol, Seth ; Braunwald, Eugene ; Mueller, Hiltrud S. / Myoglobin levels at 12 hours identify patients at low risk for 30-day mortality after thrombolysis in acute myocardial infarction : A Thrombolysis in Myocardial Infarction 10B substudy. In: American Heart Journal. 2001 ; Vol. 142, No. 1. pp. 29-36.
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abstract = "Objective: We sought to identify, by use of serum cardiac markers, patients at low risk for 30-day mortality after ST-segment elevation myocardial infarction. Background: Baseline cardiac markers are currently used to identify patients at increased risk for short-term events. We hypothesized that serum markers measured after treatment could identify patients at low risk for 30-day mortality. Methods: A total of 839 patients from the Thrombolysis in Myocardial Infarction (TIMI) 10B study had myoglobin, cardiac-specific troponin-I, creatine kinase (CK)-MB measurements at the following time points; baseline, 90 minutes, and 3 and 12 hours after thrombolysis. By use of receiver operating characteristic analysis, thresholds were derived to predict 30-day mortality with at least 95{\%} negative predictive value. Results: Ninety minutes after thrombolysis myoglobin was superior to troponin-I or CK-MB in identifying patients at low risk for mortality. The 30-day mortality for 12-hour myoglobin ≤239 ng/mL was 1.4{\%} compared with 9.1{\%} for levels >239 ng/mL (P < .001). For 12-hour troponin-I (threshold 81.5 ng/mL), mortality was 1.9{\%} versus 6.6{\%} (P = .001) if above threshold; similarly for CK-MB at 12 hours (threshold 191 ng/mL) it was 3.3{\%} versus 7.9{\%} (P = .02). Multivariate analysis of baseline and posttreatment cardiac markers, age, sex, infarct artery location, and 90-minute TIMI flow grade identified only 12-hour myoglobin among the cardiac markers as independently predicting a low 30-day mortality (odds ratio 0.11, 95{\%} confidence interval 0.02-0.50, P < .004). Conclusion: Serum cardiac markers can identify greater than two thirds of patients at low risk for 30-day mortality. A low 12-hour myoglobin level (≤239 ng/mL in this substudy) identifies such patients at low risk and could potentially assist in early risk stratification and triage after ST-segment elevation myocardial infarction.",
author = "Srinivas, {V. S.} and Cannon, {Christopher P.} and Gibson, {C. Michael} and Antman, {Elliott M.} and Greenberg, {Mark A.} and Tanasijevic, {Milenko J.} and Sabina Murphy and {De Lemos}, {James A.} and Seth Sokol and Eugene Braunwald and Mueller, {Hiltrud S.}",
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T1 - Myoglobin levels at 12 hours identify patients at low risk for 30-day mortality after thrombolysis in acute myocardial infarction

T2 - A Thrombolysis in Myocardial Infarction 10B substudy

AU - Srinivas, V. S.

AU - Cannon, Christopher P.

AU - Gibson, C. Michael

AU - Antman, Elliott M.

AU - Greenberg, Mark A.

AU - Tanasijevic, Milenko J.

AU - Murphy, Sabina

AU - De Lemos, James A.

AU - Sokol, Seth

AU - Braunwald, Eugene

AU - Mueller, Hiltrud S.

PY - 2001

Y1 - 2001

N2 - Objective: We sought to identify, by use of serum cardiac markers, patients at low risk for 30-day mortality after ST-segment elevation myocardial infarction. Background: Baseline cardiac markers are currently used to identify patients at increased risk for short-term events. We hypothesized that serum markers measured after treatment could identify patients at low risk for 30-day mortality. Methods: A total of 839 patients from the Thrombolysis in Myocardial Infarction (TIMI) 10B study had myoglobin, cardiac-specific troponin-I, creatine kinase (CK)-MB measurements at the following time points; baseline, 90 minutes, and 3 and 12 hours after thrombolysis. By use of receiver operating characteristic analysis, thresholds were derived to predict 30-day mortality with at least 95% negative predictive value. Results: Ninety minutes after thrombolysis myoglobin was superior to troponin-I or CK-MB in identifying patients at low risk for mortality. The 30-day mortality for 12-hour myoglobin ≤239 ng/mL was 1.4% compared with 9.1% for levels >239 ng/mL (P < .001). For 12-hour troponin-I (threshold 81.5 ng/mL), mortality was 1.9% versus 6.6% (P = .001) if above threshold; similarly for CK-MB at 12 hours (threshold 191 ng/mL) it was 3.3% versus 7.9% (P = .02). Multivariate analysis of baseline and posttreatment cardiac markers, age, sex, infarct artery location, and 90-minute TIMI flow grade identified only 12-hour myoglobin among the cardiac markers as independently predicting a low 30-day mortality (odds ratio 0.11, 95% confidence interval 0.02-0.50, P < .004). Conclusion: Serum cardiac markers can identify greater than two thirds of patients at low risk for 30-day mortality. A low 12-hour myoglobin level (≤239 ng/mL in this substudy) identifies such patients at low risk and could potentially assist in early risk stratification and triage after ST-segment elevation myocardial infarction.

AB - Objective: We sought to identify, by use of serum cardiac markers, patients at low risk for 30-day mortality after ST-segment elevation myocardial infarction. Background: Baseline cardiac markers are currently used to identify patients at increased risk for short-term events. We hypothesized that serum markers measured after treatment could identify patients at low risk for 30-day mortality. Methods: A total of 839 patients from the Thrombolysis in Myocardial Infarction (TIMI) 10B study had myoglobin, cardiac-specific troponin-I, creatine kinase (CK)-MB measurements at the following time points; baseline, 90 minutes, and 3 and 12 hours after thrombolysis. By use of receiver operating characteristic analysis, thresholds were derived to predict 30-day mortality with at least 95% negative predictive value. Results: Ninety minutes after thrombolysis myoglobin was superior to troponin-I or CK-MB in identifying patients at low risk for mortality. The 30-day mortality for 12-hour myoglobin ≤239 ng/mL was 1.4% compared with 9.1% for levels >239 ng/mL (P < .001). For 12-hour troponin-I (threshold 81.5 ng/mL), mortality was 1.9% versus 6.6% (P = .001) if above threshold; similarly for CK-MB at 12 hours (threshold 191 ng/mL) it was 3.3% versus 7.9% (P = .02). Multivariate analysis of baseline and posttreatment cardiac markers, age, sex, infarct artery location, and 90-minute TIMI flow grade identified only 12-hour myoglobin among the cardiac markers as independently predicting a low 30-day mortality (odds ratio 0.11, 95% confidence interval 0.02-0.50, P < .004). Conclusion: Serum cardiac markers can identify greater than two thirds of patients at low risk for 30-day mortality. A low 12-hour myoglobin level (≤239 ng/mL in this substudy) identifies such patients at low risk and could potentially assist in early risk stratification and triage after ST-segment elevation myocardial infarction.

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