Ability of myoglobin to predict mortality in patients admitted for exclusion of myocardial infarction

• Published in: The American journal of emergency medicine Vol. 25; no. 8; pp. 873 - 879
• Main Authors: Kontos, Michael C., MD, Garg, Rajat, MD, Anderson, F. Philip, PhD, Roberts, Charlotte S., MSN, Ornato, Joseph P., MD, Tatum, James L., MD, Jesse, Robert L., MD, PhD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.10.2007; Elsevier; Elsevier Limited
• Subjects: Acute coronary syndromes; Aged; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biomarkers - blood; Cardiology. Vascular system; Cardiovascular disease; Clinical death. Palliative care. Organ gift and preservation; Confidence intervals; Coronary heart disease; Creatine Kinase, MB Form - blood; Electrocardiography; Emergency; Emergency medical care; Female; Heart; Heart attacks; Humans; Intensive care medicine; Ischemia; Kinases; Male; Medical sciences; Middle Aged; Mortality; Multivariate analysis; Myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myoglobin - blood; Myoglobins; Prognosis; Renal Insufficiency - blood; Renal Insufficiency - complications; Troponin I - blood; Human; Myocardial infarction; Myoglobin; Intensive care; Heart disease; Mortality; Cardiovascular disease; Myocardial disease; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2007.01.002

Abstract Background Myoglobin can be used as an early marker to diagnose myocardial infarction (MI); and although nonspecific for myocardial necrosis, it seems to be a strong mortality predictor. Because myoglobin elevations are often present in patients with renal insufficiency, it is possible that the predictive value of myoglobin is secondary to identifying patients with renal insufficiency. Methods Consecutive patients admitted for MI exclusion without ST elevation on the initial electrocardiogram underwent serial assessment of cardiac markers (creatine kinase [CK], CK–myocardial band [MB], and troponin I [TnI]). Myoglobin was assessed at the time of admission and/or 3 hours later. Renal insufficiency was defined as a creatinine clearance <60 mL/min. Multivariate analysis was performed to identify predictors of 30-day and 1-year all-cause mortality. Results A total of 3461 patients were included in the analysis. Overall 30-day and 1-year mortality was 2.4% and 9.7%. Myoglobin was elevated in 675 (20%), CK-MB in 421 (12%), and TnI in 517 (15%). Among the 993 patients with renal insufficiency, myoglobin was elevated in 43%, CK-MB in 17%, and TnI in 21%. Independent predictors of 30-day and 1-year mortality were similar and included age ≥65 years, prior MI, and an ischemic electrocardiogram, whereas myoglobin was the strongest multivariate predictor (odds ratio [OR] 2.8, 95% confidence interval [CI] 2.1-3.7), including those with renal insufficiency (OR 2.3, 95% CI 1.6-3.4). Troponin I had borderline predictive value ( P = .08, OR 1.4, 95% CI 0.96-2.0), whereas CK-MB was not predictive in either group. Conclusions Despite the absence of cardiac specificity, an elevated myoglobin strongly predicts mortality, even in patients with renal insufficiency.