Assessment of Acute Myocardial infarction by the use of special biochemical markers

Acute Myocardial infarction AMI occurs during the period when circulation to a region of the heart is obstructed and necrosis ensues. The objective of this study was to estimate the levels of serum Myoglobin and enzymes as cardiac marker for diagnosis of early Myocardial Infarction. This was case control hospital based study involving 130 patients admitted to Elshaab Teaching Hospital and Sudan Heart Center, suffering chest pain, wherein all patients were taken immediately to Coronary Care Unit CCU . 30 apparently healthy people were enrolled as control. This study was conducted between March and October 2010. The age ranged between 39-60 years . Blood samples were collected for the estimation of Myoglobin using fully automatic immunoanalyzer and cardiac enzymes were measured using Spectrophotometer. The mean levels of myoglobin concentration in different patients at admission and after 24 hrs of admission to the hospital was 563 ng/ml and 34 ng/ml for patients and control respectively. The level remained higher even after 24 hrs of admission 414 ng/ml . Creatine kinase dramatically elevated within the first 24 hrs in all patients admitted to hospital during 6, 10, 20, 24 and 48 hrs following chest pain attack. CK-MB gradually elevated in patients admitted 6, 10, 20, 24 and 48 hrs from chest pain attack, reaching a peak after 24 hrs of chest pain attack, and then CK-MB levels declined to normal values after 48 hrs. The LDH level exhibited increase levels in patients admitted 6, 10, 20, 24 and 48 hrs from chest pain attack, and the levels persisted all through 24 hrs irrespective of the time admission to the hospital following chest pain. AST level was not elevated after 6 hrs or 10 hrs following the chest pain attack, but a dramatic elevation was seen after 24 hrs following hospital admission, however, increased levels of AST was noticed in patients admitted to hospital after 24 or 48 hrs following the attack. The levels were within the normal value in patients admitted after 48 hrs of the chest pain attack, and remain so following 24 hrs of admission. This study indicated that Myoglobin and CK-MB are more sensitive cardiac markers compared to total CK, LDH and AST for the diagnosis of Myocardial Infarction.

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  • Abe, J. Yamaguchi, T. Isshiki, T; Myocardial reperfusion can be predicated by myoglobin/creatine kinase ratio of a single blood sample obtained at the time of admission. Am. Heart J., : 279-285, 1993.
  • Abramson, J. H; Risk markers for mortality among elderly men community study in Jerusalem, J. Chronic disease; 35: 563- , 1982.
  • Allain CC, et al; American Heart Association; Coronary Risk Handbook. Estimating Risk of Coronary Heart Disease in daily practice. Clin Chem, 20: 470-475, 1974.
  • Bakker, AJ; Koelemay, MW; Gorgels; J.Failure of new biochemical markers to exclude acute MI at admission Lancer, , 1220-2, 1993
  • Chapelle, J.P., Allaf, M.E; Determination of myoglobin in serum by kinetic turbidimetry using the turbitime system. Clin. Chem., 36: 1193, 1990.
  • Drexel, H., Dworzak, E., Kirchmair, W; Myoglobinemia in the early phase of acute myocardial infarction. Am. Heart J., : 642-650, 1983.
  • Ellis, A. K., Little, T., Masvil, A. R. Z; Early noninvasive detection of successful reperfusion in patients with acute myocardial infarction. Circulation, 78: 1352-1357, 1988.
  • Gibler, W. B., Lewis, L. M., Erb, R. E; Early detection of acute myocardial infarction in patients presenting with chest pain and ECGs: Serial CK-MB sampling in the emergancy department. Ann. Emerg. Med., 19: 1359-1366, 1990.
  • Gibler, W.B., Gibler, C.D., Weinshenker, E; Myoglobin as an early indicator of acute myocardial infarction. Ann. Emerg. Med., 16: 851-856, 1987.
  • Gibler, W.B., Runyon, J.P., Levy, R.C; A rapid diagnostic and treatment center for patients with chest pain in the emergency department. Ann. Emerg. Med. 25: 1-8,1995.
  • Griesmacher, A., Grimm, M., Schreiner, R., Müller, M.M; Diagnosis of preoperative myocardial infarction by considering relationship of postoperative electrocardiogram changes and enzyme increases after coronary bypass operation. Clin. Chem., : 883-887, 1990.
  • IFCC method for the measurement of catalytic concentration of enzyme. J Clin Chem Clin Biochem, 24: 497-510, 1986.
  • IFCC methods for measurement of catalytic concentration of enzyme. JIFCC, 1: 130-139, 1989.
  • Katrukha, A.G., Bereznikova, A.V., Esakova, T.V; Troponin I is released in bloodstream of patients with acute myocardial infarction not in free form but as complex. Clin. Chem., 43: 1385, 1997.
  • Laperche, T., Steg, P.G., Benessiano, J; Patterns of myoglobin and MM creatine kinase isoform release early after intravenous thrombolysis or direct percutaneous transluminal coronary angioplasty for acute myocardial infarction, and implications for the early noninvasive diagnosis of reperfusion. Am. J. Cardiol., 70: 1129-1134, 1992.
  • Lee, T.H., Goldman, L; Serum enzyme assays in diagnosis of acute myocardial infarction. Ann. Intern. Med., 105: 221-233, Leung, F.T., Galbraith, L.V., Jablonsky, G., Henderson, A.R; Re-evaluation of the diagnostic utility of serum total creatine kinase and creatine kinase-2 in myocardial infarction. Clin Chem., 35: 1435-1440, 1989.
  • Lindahl. B, Venge. P, Wallentin. L; Early diagnosis and exclusion of acute Myocardial Infarction using biochemical monitoring. The BIOMACS study group, biochemical markers of acute coronory syndrome. Coron Artery Dis, 6: 321-8, 1995.
  • Collinson, L. Sylven, C., Santonyi, p; Lactate dehydrogenase and its isoenzyme activities in different parts of normal human heart. Cardiovasc. Res., 23: 601-606, 1989.
  • Mair. S, Morandell. D; Equivalent early sensitivities of Myoglobin, CK-MB, CK isoform ratios and cardiac Troponins I and T for acute MI. Clin. Chem. 41: 1266-72, 1995.
  • Newby, L. K; Gibler, W. B. Ohman, E. M; Biochemical markers in suspected acute MI the need for early assessment. Clin. Chem. 41: 1263-5, 1995.
  • Ravkidle, J., Nissen, H., Horder, M., Thygesen, K; Independent prognostic value of serum creatine kinase isoenzyme MB mass, cardiac troponin T and myosin light chain levels in suspected acute myocardial infarction. J. Am. Coll. Cardiol., 25: 574-581, 1995.
  • Vaananen, H. K., Syrjala, H., Rahkila, P; Serum carbonic anhydrase III and myoglobin concentrations in acute myocardial infarction. Clin. Chem., 36: 635-638, 1990.
  • Wu, A.H.B., Gorent, T.G., Harker, C.C; Role of rapid immunoassay for urgent determinations of creatine kinase isoenzyme MB. Clin. Chem., 35: 1752-1756, 1989.
  • Zabel M, Hohnloser, S.H., Koster, W; Analysis of creatine.kinase, CK-2, myoglobin, and troponin T time-ac0tivity curves for early assessment of coronary artery reperfusion after intravenous thrombolysis. Circulation, 87: 1542-1550, 1993.