SUMMARY Serum myoglobin concentration and creatine kinase activity were measured serially in 70 consecutive patients presenting within four hours of the onset of symptoms of suspected acute myocardial infarction. Of 36 patients with definite or possible myocardial infarction (WHO criteria), the serum myoglobin concentration was raised (>85 ,g/l) one hour after the onset of symptoms in 25% and at four hours in 890/o. Creatine kinase activity was raised (>140 U/1) one hour after the onset in 25% and at four hours in only 56%. Within 12 hours of the onset of symptoms the myoglobin concentration reached a peak in 83% and the creatine kinase a peak in only 14%. Within 36 hours the myoglobin concentration fell to normal values in 67% while creatine kinase activity fell to normal values in only 3%. Four hours after the onset of symptoms the serum myoglobin concentration distinguished easily those patients with myocardial infarction from those without, whereas when creatine kinase values were used the sensitivity was poor but the specificity high.From the combined results of the two studies and using a single measurement of serum myoglobin concentration at six hours from the onset of symptoms to predict the diagnosis in 114 patients with suspected infarction, the sensitivity was 93% and specificity 890/o.Kiss and Reinhart' first reported abnormal serum PART 1 concentrations of myoglobin 10 to 12 hours after acute Seventy consecutive patients with symptoms suggesmyocardial infarction. Since then, others have ting acute myocardial infarction-that is, typical disconfirmed that most patients with acute myocardial tribution of chest pain with or without electrocardioinfarction have a raised serum myoglobin concentra-graphic changes-and presenting to a mobile and tion shortly after admission to hospital.2-5 Sylven, hospital coronary care unit within four hours of the using data from 40 patients admitted within six hours onset of symptoms were studied. Blood samples were of the onset of symptoms of infarction, estimated that obtained at the time of presentation and at two hourly 20% would have raised serum myoglobin concentra-intervals for 48 hours using an indwelling cannula. tions one hour after the onset of symptoms.6Using an automated colorimetric technique serum Using a mobile coronary care unit we are able to creatine kinase activity was measured in the assess patients at an earlier stage after myocardial refrigerated serum.7 Serum myoglobin concentration infarction. In this study we compared the serum was measured in the frozen serum using a myoglobin concentration with the serum creatine kin-radioimmunoassay (Nuclear Medical Systems).

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