Markers of successful reperfusion from fibrinolysis in acute STEMI

Q: Out of the following which markers are preferable in to predict successful reperfusion from fibrinolysis in acute ST elevation myocardial infarction (STEMI)?

A) CK-MB
B) Myoglobin
C) Troponin
D) A and B
E) Reperfusion arrhythmias


Answer: 

Troponin is now treated like a holy grail in STEMI but rapidly rising and falling CK-MB or/and myoglobin are more reliable indicator of successful reperfusion after fibrinolysis in STEMI. Although reperfusion arrhythmia is common after successful fibrinolysis in acute STEMI, it is neither a sensitive nor a specific sign.


References:

1. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction. www.acc.org/qualityandscience/clinical/statements.htm 

2. Christenson RH, Ohman EM, Topol EJ, et al. Assessment of coronary reperfusion after thrombolysis with a model combining myoglobin, creatine kinase-MB, and clinical variables. TAMI-7 Study Group. Thrombolysis and Angioplasty in Myocardial Infarction-7. Circulation 1997; 96:1776. 

3. Tanasijevic MJ, Cannon CP, Antman EM, et al. Myoglobin, creatine-kinase-MB and cardiac troponin-I 60-minute ratios predict infarct-related artery patency after thrombolysis for acute myocardial infarction: results from the Thrombolysis in Myocardial Infarction study (TIMI) 10B. J Am Coll Cardiol 1999; 34:739. 

4. Berger PB, Ruocco NA, Ryan TJ, et al. Incidence and significance of ventricular tachycardia and fibrillation in the absence of hypotension or heart failure in acute myocardial infarction treated with recombinant tissue-type plasminogen activator: results from the Thrombolysis in Myocardial Infarction (TIMI) Phase II trial. J Am Coll Cardiol 1993; 22:1773.