The prognostic value of serum myoglobin in patients with non-ST-segment elevation acute coronary syndromes: Results from the TIMI 11B and TACTICS-TIMI 18 studies

James A de Lemos, David A. Morrow, C. Michael Gibson, Sabina A. Murphy, Marc S. Sabatine, Nader Rifai, Carolyn H. McCabe, Elliott M. Antman, Christopher P. Cannon, Eugene Braunwald

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Abstract

OBJECTIVES. The goal of this study was to define the prognostic value of serum myoglobin in patients with non-ST-elevation acute coronary syndromes (ACS). BACKGROUND. While myoglobin is useful for the early diagnosis of myocardial infarction (MI), its role in the early risk-stratification of patients with ACS has not been established. METHODS. Myoglobin, creatine kinase-MB subfraction (CK-MB)and troponin I (cTnI) were measured at randomization in 616 patients from the Thrornbolysis In Myocardial Ischernia/Infarction (TIMI) 11B study and 1,841 patients from the Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Therapy-Thrombolysis In Myocardial Ischemia/Infarction (TACTICS-TIMI) 18 study. The risks for death and nonfatal MI through six months of follow-up were compared between patients with and without myoglobin elevation (> 110 μg/l) in each study and in a dataset combining all eligible patients from both studies (n = 2,457). RESULTS. In a multivariate model adjusting for baseline characteristics, ST changes and CK-MB and cTnI levels, an elevated baseline myoglobin was associated with increased six-month mortality in TIMI 11B (adjusted odds ratio [OR] 2.9 [95% confidence interval {CI} 1.2 to 7.1]), TACTICS-TIMI 18 (adjusted OR 3.0 [95% CI 1.5 to 5.9]) and the combined dataset (adjusted OR 3.0 [95% CI 1.8 to 5.0]). In contrast, there was no significant association between myoglobin elevation and nonfatal MI (combined dataset adjusted OR 1.55, 95% CI 0.9 to 2.6). In TACTICS-TIMI 18, patients with versus those without myoglobin elevation were more likely to have an occluded culprit artery (28% vs. 10%; p < 0.0001) and visible thrombus (49% vs. 34%; p = 0.006) and less likely to have TIMI 3 flow (53% vs. 68%; p = 0.009). CONCLUSIONS. A serum concentration of myoglobin above the MI detection threshold (>110 μg/l) is associated with an increased risk of six-month mortality, independent of baseline clinical characteristics, electrocardiographic changes and elevation in CK-MB and cTnI. These findings suggest that myoglobin may be a useful addition to cardiac biomarker panels for early risk-stratification in ACS.

Original languageEnglish (US)
Pages (from-to)238-244
Number of pages7
JournalJournal of the American College of Cardiology
Volume40
Issue number2
DOIs
StatePublished - Jul 17 2002

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Myoglobin
Acute Coronary Syndrome
Myocardial Infarction
Serum
MB Form Creatine Kinase
Troponin I
Odds Ratio
Confidence Intervals
tirofiban
Mortality
Random Allocation
Myocardial Ischemia
Early Diagnosis
Arteries
Biomarkers
Costs and Cost Analysis

ASJC Scopus subject areas

  • Nursing(all)

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The prognostic value of serum myoglobin in patients with non-ST-segment elevation acute coronary syndromes : Results from the TIMI 11B and TACTICS-TIMI 18 studies. / de Lemos, James A; Morrow, David A.; Gibson, C. Michael; Murphy, Sabina A.; Sabatine, Marc S.; Rifai, Nader; McCabe, Carolyn H.; Antman, Elliott M.; Cannon, Christopher P.; Braunwald, Eugene.

In: Journal of the American College of Cardiology, Vol. 40, No. 2, 17.07.2002, p. 238-244.

Research output: Contribution to journalArticle

de Lemos, James A ; Morrow, David A. ; Gibson, C. Michael ; Murphy, Sabina A. ; Sabatine, Marc S. ; Rifai, Nader ; McCabe, Carolyn H. ; Antman, Elliott M. ; Cannon, Christopher P. ; Braunwald, Eugene. / The prognostic value of serum myoglobin in patients with non-ST-segment elevation acute coronary syndromes : Results from the TIMI 11B and TACTICS-TIMI 18 studies. In: Journal of the American College of Cardiology. 2002 ; Vol. 40, No. 2. pp. 238-244.
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title = "The prognostic value of serum myoglobin in patients with non-ST-segment elevation acute coronary syndromes: Results from the TIMI 11B and TACTICS-TIMI 18 studies",
abstract = "OBJECTIVES. The goal of this study was to define the prognostic value of serum myoglobin in patients with non-ST-elevation acute coronary syndromes (ACS). BACKGROUND. While myoglobin is useful for the early diagnosis of myocardial infarction (MI), its role in the early risk-stratification of patients with ACS has not been established. METHODS. Myoglobin, creatine kinase-MB subfraction (CK-MB)and troponin I (cTnI) were measured at randomization in 616 patients from the Thrornbolysis In Myocardial Ischernia/Infarction (TIMI) 11B study and 1,841 patients from the Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Therapy-Thrombolysis In Myocardial Ischemia/Infarction (TACTICS-TIMI) 18 study. The risks for death and nonfatal MI through six months of follow-up were compared between patients with and without myoglobin elevation (> 110 μg/l) in each study and in a dataset combining all eligible patients from both studies (n = 2,457). RESULTS. In a multivariate model adjusting for baseline characteristics, ST changes and CK-MB and cTnI levels, an elevated baseline myoglobin was associated with increased six-month mortality in TIMI 11B (adjusted odds ratio [OR] 2.9 [95{\%} confidence interval {CI} 1.2 to 7.1]), TACTICS-TIMI 18 (adjusted OR 3.0 [95{\%} CI 1.5 to 5.9]) and the combined dataset (adjusted OR 3.0 [95{\%} CI 1.8 to 5.0]). In contrast, there was no significant association between myoglobin elevation and nonfatal MI (combined dataset adjusted OR 1.55, 95{\%} CI 0.9 to 2.6). In TACTICS-TIMI 18, patients with versus those without myoglobin elevation were more likely to have an occluded culprit artery (28{\%} vs. 10{\%}; p < 0.0001) and visible thrombus (49{\%} vs. 34{\%}; p = 0.006) and less likely to have TIMI 3 flow (53{\%} vs. 68{\%}; p = 0.009). CONCLUSIONS. A serum concentration of myoglobin above the MI detection threshold (>110 μg/l) is associated with an increased risk of six-month mortality, independent of baseline clinical characteristics, electrocardiographic changes and elevation in CK-MB and cTnI. These findings suggest that myoglobin may be a useful addition to cardiac biomarker panels for early risk-stratification in ACS.",
author = "{de Lemos}, {James A} and Morrow, {David A.} and Gibson, {C. Michael} and Murphy, {Sabina A.} and Sabatine, {Marc S.} and Nader Rifai and McCabe, {Carolyn H.} and Antman, {Elliott M.} and Cannon, {Christopher P.} and Eugene Braunwald",
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T1 - The prognostic value of serum myoglobin in patients with non-ST-segment elevation acute coronary syndromes

T2 - Results from the TIMI 11B and TACTICS-TIMI 18 studies

AU - de Lemos, James A

AU - Morrow, David A.

AU - Gibson, C. Michael

AU - Murphy, Sabina A.

AU - Sabatine, Marc S.

AU - Rifai, Nader

AU - McCabe, Carolyn H.

AU - Antman, Elliott M.

AU - Cannon, Christopher P.

AU - Braunwald, Eugene

PY - 2002/7/17

Y1 - 2002/7/17

N2 - OBJECTIVES. The goal of this study was to define the prognostic value of serum myoglobin in patients with non-ST-elevation acute coronary syndromes (ACS). BACKGROUND. While myoglobin is useful for the early diagnosis of myocardial infarction (MI), its role in the early risk-stratification of patients with ACS has not been established. METHODS. Myoglobin, creatine kinase-MB subfraction (CK-MB)and troponin I (cTnI) were measured at randomization in 616 patients from the Thrornbolysis In Myocardial Ischernia/Infarction (TIMI) 11B study and 1,841 patients from the Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Therapy-Thrombolysis In Myocardial Ischemia/Infarction (TACTICS-TIMI) 18 study. The risks for death and nonfatal MI through six months of follow-up were compared between patients with and without myoglobin elevation (> 110 μg/l) in each study and in a dataset combining all eligible patients from both studies (n = 2,457). RESULTS. In a multivariate model adjusting for baseline characteristics, ST changes and CK-MB and cTnI levels, an elevated baseline myoglobin was associated with increased six-month mortality in TIMI 11B (adjusted odds ratio [OR] 2.9 [95% confidence interval {CI} 1.2 to 7.1]), TACTICS-TIMI 18 (adjusted OR 3.0 [95% CI 1.5 to 5.9]) and the combined dataset (adjusted OR 3.0 [95% CI 1.8 to 5.0]). In contrast, there was no significant association between myoglobin elevation and nonfatal MI (combined dataset adjusted OR 1.55, 95% CI 0.9 to 2.6). In TACTICS-TIMI 18, patients with versus those without myoglobin elevation were more likely to have an occluded culprit artery (28% vs. 10%; p < 0.0001) and visible thrombus (49% vs. 34%; p = 0.006) and less likely to have TIMI 3 flow (53% vs. 68%; p = 0.009). CONCLUSIONS. A serum concentration of myoglobin above the MI detection threshold (>110 μg/l) is associated with an increased risk of six-month mortality, independent of baseline clinical characteristics, electrocardiographic changes and elevation in CK-MB and cTnI. These findings suggest that myoglobin may be a useful addition to cardiac biomarker panels for early risk-stratification in ACS.

AB - OBJECTIVES. The goal of this study was to define the prognostic value of serum myoglobin in patients with non-ST-elevation acute coronary syndromes (ACS). BACKGROUND. While myoglobin is useful for the early diagnosis of myocardial infarction (MI), its role in the early risk-stratification of patients with ACS has not been established. METHODS. Myoglobin, creatine kinase-MB subfraction (CK-MB)and troponin I (cTnI) were measured at randomization in 616 patients from the Thrornbolysis In Myocardial Ischernia/Infarction (TIMI) 11B study and 1,841 patients from the Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Therapy-Thrombolysis In Myocardial Ischemia/Infarction (TACTICS-TIMI) 18 study. The risks for death and nonfatal MI through six months of follow-up were compared between patients with and without myoglobin elevation (> 110 μg/l) in each study and in a dataset combining all eligible patients from both studies (n = 2,457). RESULTS. In a multivariate model adjusting for baseline characteristics, ST changes and CK-MB and cTnI levels, an elevated baseline myoglobin was associated with increased six-month mortality in TIMI 11B (adjusted odds ratio [OR] 2.9 [95% confidence interval {CI} 1.2 to 7.1]), TACTICS-TIMI 18 (adjusted OR 3.0 [95% CI 1.5 to 5.9]) and the combined dataset (adjusted OR 3.0 [95% CI 1.8 to 5.0]). In contrast, there was no significant association between myoglobin elevation and nonfatal MI (combined dataset adjusted OR 1.55, 95% CI 0.9 to 2.6). In TACTICS-TIMI 18, patients with versus those without myoglobin elevation were more likely to have an occluded culprit artery (28% vs. 10%; p < 0.0001) and visible thrombus (49% vs. 34%; p = 0.006) and less likely to have TIMI 3 flow (53% vs. 68%; p = 0.009). CONCLUSIONS. A serum concentration of myoglobin above the MI detection threshold (>110 μg/l) is associated with an increased risk of six-month mortality, independent of baseline clinical characteristics, electrocardiographic changes and elevation in CK-MB and cTnI. These findings suggest that myoglobin may be a useful addition to cardiac biomarker panels for early risk-stratification in ACS.

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