Tanasijevic M J, Cannon C P, Wybenga D R, Fischer G A, Grudzien C, Gibson C M, Winkelman J W, Antman E M, Braunwald E
Clinical Laboratories, Brigham and Women's Hospital, Boston, MA 02115, USA.
Am Heart J. 1997 Oct;134(4):622-30. doi: 10.1016/s0002-8703(97)70044-9.
The availability of a reliable, noninvasive serum marker of reperfusion may permit early identification of patients with occlusion after thrombolysis who might benefit from further interventions.
We measured myoglobin, creatine kinase MB (CK-MB), and cardiac troponin-I (cTnI) concentrations in sera obtained just before thrombolysis (T0) and 60 minutes later (T60) in 30 patients given TNK-tPA for acute myocardial infarction as part of the Thrombolysis in Myocardial Infarction (TIMI) 10A trial.
Angiography at T60 showed reperfusion (TIMI flow grade 2 to 3; n = 19) or occlusion (TIMI flow grade 0 to 1; n = 8). The median serum T60 concentration, the ratio of the T60 and T0 serum concentration, and the slope of increase over a 60-minute period for each serum marker were significantly higher in patients with patent arteries compared with patients with occluded arteries. The areas under the receiver operator characteristics curve for diagnosis of occlusion were 0.96, 0.91, and 0.87 for the T60 concentration of myoglobin, CK-MB and cTnI, respectively. Although the T60 levels of <469 ng/ml for myoglobin, <11.5 ng/ml for CK-MB, and < 1.1 ng/ml for cTnI identified all patients with occlusion, the specificity of myoglobin (94%) was higher than that of CK-MB (61%) and cTnI (67%). Similar results were obtained for the 60-minute ratios and 60-minute slopes for each marker, with indexes for myoglobin having the highest specificity.
In this pilot study, noninvasive diagnosis of occlusion 60 minutes after thrombolysis was achieved with a high degree of sensitivity and specificity with the myoglobin, CK-MB, and cTnI concentrations measured at that time point. These preliminary findings may permit a new strategy for assessment of the success of reperfusion, with triage to rescue angioplasty for patients in whom the 60-minute cardiac marker values or indexes are consistent with occlusion of the infarct-related artery.
一种可靠的、非侵入性的再灌注血清标志物的出现，可能有助于早期识别溶栓后发生血管闭塞且可能从进一步干预中获益的患者。
在心肌梗死溶栓治疗（TIMI）10A试验中，我们测定了30例接受替奈普酶（TNK - tPA）治疗急性心肌梗死患者溶栓前（T0）和60分钟后（T60）血清中的肌红蛋白、肌酸激酶同工酶MB（CK - MB）和心肌肌钙蛋白I（cTnI）浓度。
T60时的血管造影显示再灌注（TIMI血流分级2至3级；n = 19）或闭塞（TIMI血流分级0至1级；n = 8）。与血管闭塞患者相比，血管通畅患者每种血清标志物的T60血清浓度中位数、T60与T0血清浓度之比以及60分钟内的升高斜率均显著更高。肌红蛋白、CK - MB和cTnI的T60浓度用于诊断闭塞的受试者操作特征曲线下面积分别为0.96、0.91和0.87。虽然肌红蛋白T60水平<469 ng/ml、CK - MB<11.5 ng/ml和cTnI<1.1 ng/ml可识别所有闭塞患者，但肌红蛋白的特异性（94%）高于CK - MB（61%）和cTnI（67%）。每种标志物的60分钟比值和60分钟斜率也得到了类似结果，肌红蛋白的指标特异性最高。
在这项初步研究中，通过测定该时间点的肌红蛋白、CK - MB和cTnI浓度，对溶栓后60分钟的血管闭塞进行非侵入性诊断具有高度的敏感性和特异性。这些初步发现可能为评估再灌注成功与否提供一种新策略，对于60分钟心脏标志物值或指标与梗死相关动脉闭塞一致的患者，可分流至补救性血管成形术。
