SUMMARY. We have measured changes in plasma concentration of creatine kinase MB (CK-MB) and myoglobin in 50 patients admitted to the Coronary Care Unit with chest pain of presumed cardiac origin. Eight serial blood samples were obtained in the 6 h period following admission and both CK-MB and myoglobin concentrations were measured.We compared the performance of single values of both tests. Myoglobin concentration, in the coronary care population studied, proved to be as specific as CK-MB concentration (92' 6% in both cases) but with sensitivity of 100% being achieved 1· 5 h post admission rather than 4 h post admission in the case of CK-MB.On this evidence, measurement of plasma myoglobin could prove useful in the rapid diagnosis of myocardial infarction with consequent effects on optimal Coronary Care utilisation and selection of patients for thrombolytic therapy.

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The Diabetes Control and Complications Trial (DCCT) has provided objective evidence for desirable glycaemic control in Type 1 patients and defines the benefits of good glycaemic control in terms of haemoglobin A1c (HbA1c) values. However, HbA1c assays vary, leading to suggestions that glycaemic control be classified according to numbers of standard deviations (SD) from a local non-diabetic population mean. We have classified the glycaemic control of 339 UK Type 1 diabetic patients (182 male, 157 female, median age 36 (range 15-74) years) using the DCCT to set HbA1c targets and compared this with the SD method. Using age matched controls (mean HbA1c 4.02%, SD 0.28%, n=106), SD guidelines classified 1% of patients into good (HbA1c <3SD from reference mean), 4% into borderline (3-5SD) and 95% into poor (>5SD) glycaemic control. When calibrating the same instrument to the DCCT analyser (r=0.996), 37% of patients had HbA1c results lower than the 7% median value found in the intensively treated DCCT group, while only 12% of patients had values greater than the 9% conventionally treated median HbA1c. DCCT subjects with HbA1c values of less than 8% belonged predominantly to the intensively treated group. In this study, 71% of patients fell into this category. Thus, guidelines based on numbers of SD away from a non-diabetic mean may overestimate the glycaemic control required to reduce microvascular complications in Type 1 patients. Standardizing to DCCT targets is more appropriate.

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