Myoglobin

Abstract

Although myoglobin was demonstrated to appear in blood and urine in the course of acute myocardial infarction (AMI) as early as 1956 by Kiss and Reinhard [1], for the next two decades enzyme determinations were preferred for the biochemical diagnosis of myocardial necrosis for methodological reasons. The first radioimmunoassay for the quantification of serum myoglobin was reported in 1975 [2]. This new technology made possible for the first time the accurate measurement of myoglobin concentrations in blood, and plasma myoglobin elevation after AMI was re-emphasised. However, many authors were not able to detect myoglobin in urine despite relatively high plasma concentrations [3], and it appears that myoglobin is only detectable in urine after extensive AMIs which release high amounts of myoglobin. It soon turned out, and was repeatedly demonstrated, that myoglobin concentrations rise several hours earlier after the onset of chest pain than creatine kinase (CK) and CKMB enzyme activities [2–5]. Since then myoglobin has become an established early marker for myocardial infarction and is a standard against which all new markers proposed for early AMI diagnosis have to be compared. However, in the 1970’s myoglobin determinations, were mainly of academic interest because these radioimmunoassays were too time consuming (the results were only available on the next day or even later), and additionally the earlier diagnosis of AMI had at this time no real clinical consequences for patient care and management. During recent years the rapid early diagnosis of AMI using biochemical markers has received increasing attention, in particular for early exclusion of AMI in patients with non-diagnostic electrocardiogram (ECG) because of the increasing economic need for cost-effective utilisation of expensive coronary care units. This has forced assay manufacturers to overcome analytical limitations, and now-a-days rapid, automated immunoassays for plasma and whole blood myoglobin measurement are available.KeywordsAcute Myocardial InfarctionCreatine KinaseAcute Myocardial InfarctionAcute Myocardial Infarction PatientCoronary Artery Bypass Grafting PatientThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.