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Very early risk stratification after thrombolytic therapy with a bedside myoglobin assay and the 12-lead

J A De Lemos1, E M Antman, R P Giugliano

  • 1Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. jdelemos@rics.bwh.harvard.edu

American Heart Journal
|August 31, 2000
PubMed

Insights

A negative baseline myoglobin assay and complete ST resolution significantly reduce mortality risk in ST-segment elevation myocardial infarction patients. These rapid tests aid early risk stratification and patient triage after thrombolytic therapy.

Area of Science:

  • Cardiology
  • Biomarkers
  • Diagnostic Tools

Background:

  • Current prognosis criteria for ST-elevation myocardial infarction (STEMI) lack consideration of reperfusion therapy and baseline cardiac markers.
  • There is a need for improved risk stratification tools in STEMI management.

Purpose of the Study:

  • To evaluate the combined utility of a baseline myoglobin assay and early ST-segment resolution for risk stratification in STEMI patients.
  • To assess the predictive value of these markers for 30-day mortality.

Main Methods:

  • A prospective substudy of the InTIME-II trial included 2079 STEMI patients.
  • Baseline myoglobin levels were assessed immediately before thrombolysis.
  • Serial electrocardiograms were used to categorize ST-segment resolution at 60-90 minutes post-thrombolysis.

Main Results:

  • A negative baseline myoglobin assay was associated with a 3.3% mortality rate versus 8.9% for a positive assay (P <.0001).
  • Complete ST resolution correlated with the lowest mortality (2.4%), while no ST resolution had the highest (8.1%) (P <.0001 for trend).
  • Both positive myoglobin and ST resolution <70% were independent predictors of increased 30-day mortality.

Conclusions:

  • A bedside risk assessment using myoglobin assay and ST resolution is feasible within 90 minutes post-thrombolysis.
  • This strategy offers a simple, rapid, and inexpensive method for patient triage after thrombolytic therapy.
  • Early identification of high-risk patients can guide subsequent management decisions.
Abstract

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