Prospective Evaluation of Reperfusion Markers - PERM

Description:

Biochemical methods for detecting early patency after thrombolysis.

Hypothesis:

To evaluate biochemical methods for early patency after thrombolysis and to establish the optimal diagnostic criteria retrospectively.

Study Design

Study Design:

Patients Screened: Not given
Patients Enrolled: 97
Mean Follow Up: 90 minutes
Mean Patient Age: 59
Female: 15

Patient Populations:

Acute MI within 6 hours
In-hospital treatment with intravenous thrombolytics

Primary Endpoints:

Biochemical markers, 90 minute infarct-related artery patency.

Drug/Procedures Used:

Measurements of myoglobin, troponin T, creatine kinase (CK), creatine kinase MB isoenzyme (CK-MB) and creatine kinase MM isoenzyme (CK-MM).

Concomitant Medications:

The thrombolytic agent was t-PA in 56 patients, streptokinase in 34 patients, combined t-PA and streptokinase in 6 patients, and combined t-PA and urokinase in 1 patient.

Principal Findings:

The diagnostic performance of all the markers was markedly improved when patients were stratified according to the time until treatment and when the analysis was restricted to those patients treated > 3 hours after the onset of symptoms (n=49)

With receiver operator charateristic 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 (c-indices 0.84, 0.83, and 0.85, respectively).

Interpretation:

This study showed that the diagnostic performance (sensitivity and specificity) of biochemical markers, when collected prospectively, did not match that observed in previous studies. The diagnostic value of some methods may be particularly sensitive to changes in the threshold value. In the overall cohort, the performance of most markers was acceptable, with c-indices ranging from 0.56 to 0.72 (where a value of 0.5 is equal to chance). The improved performance observed for patients > 3 hours after the onset of symptoms likely resulted from the delay between symptom onset and elevation of marker plasma levels.

References:

1. Circulation 1995;92:2079-86

Clinical Topics: Dyslipidemia, Lipid Metabolism

Keywords: Isoenzymes, Creatine Kinase, Streptokinase, Biological Markers, Myoglobin, Creatine Kinase, MB Form, Troponin T, Coronary Disease, Fibrinolytic Agents, Tissue Plasminogen Activator


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