Biochemical markers of thrombolytic success. IFCC Committee on Standardization of Markers of Cardiac Damage.

This paper reviews the clinical criteria necessary for use of thrombolytic drug therapy, the role of monitoring biochemical markers for detection of successful reperfusion following thrombolytic therapy, and the role of monitoring markers following percutaneous intervention to assess risk. Review of several studies demonstrates that early monitoring of myoglobin, cardiac troponin I, cardiac troponin T, and CK MB mass provides greater than 80% sensitivity and specificity for detecting reperfusion within 90 minutes following the initiation of therapy. However, the number of acute myocardial infarction patients studied are small. Since no prospective studies are reported, additional studies are necessary prior to clinical acceptance of routine monitoring of markers for detection of reperfusion. Most important, TIMI 3 flow patients cannot be differentiated from TIMI 2 flow patients. Monitoring markers after PTCA does appear to assist in short term (30 day) risk stratification. However, more studies are needed to assess the use of cardiac troponins.