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Objectives: To determine the sensitivity and specificity of a new myoglobin assay for acute myocardial infarction (AMI), considering both the total amount of serum myoglobin and its percentage change over 2 hours. Methods:A prospective, observational test performance study for the recognition of AM1 was done using serial myoglobin assays of 42 admitted chest pain patients at a large, urban teaching hospital ED. Myoglobin testing was performed at presentation (time 0) and at 1 and 2 hours after arrival. A myoglobin level >lo0 pg/L (ng/mL) or a change 250% from baseline (increase or decrease) any time during the 2-hour period was considered positive. Patients and their physicians were blinded to the myoglobin results. The managing clinician's final diagnosis of the presenting event was used as the diagnostic criterion standard. Results:The sensitivity of the myoglobin technique for detection of AM1 in the first hours in the ED was 13/14 (93%; 95% CI: 66-100%). The 1 patient who had a false-negative test had evidence of AM1 on the ECG and an initially abnormal creatine kinase-MB (CK-MB) assay. The specificity was 22/28 (79%; 59-92%). However, of the 6 patients who had "false-positive" myoglobin tests, all had serious illness: significant cardiac disease (n = 4), in-hospital death (n = l), or deep venous thrombosis (n = 1). Conclusion:Myoglobin level determinations are sensitive tests to detect AM1 during the first 2 hours of a patient's stay in the ED and may complement current clinical tools.

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