Additional ST segment elevation during the first hour of thrombolytic therapy: an electrocardiographic sign predicting a favorable clinical outcome.
OBJECTIVE
The aim of this study was to investigate the significance of further ST elevation that occurs during the 1st h of thrombolytic therapy before the expected resolution.


BACKGROUND
Early resolution of ST segment elevation is commonly accepted as a marker of clinical reperfusion during thrombolytic therapy for acute myocardial infarction. Using frequent electrocardiographic recordings, we observed in some patients further ST elevation that occurred during hour 1 of thrombolysis before the expected resolution.


METHODS
To investigate the significance of this pattern, we classified 177 consecutive patients with a first acute myocardial infarction into two groups: Group A, 98 patients with ST elevation > or = 1 mm above the initial ST elevation during the 1st h of thrombolytic therapy, and Group B, 79 patients without this finding.


RESULTS
Although the presence or absence of additional ST elevation was not associated with a clinical or prognostic difference in patients with a first inferior or posterior acute myocardial infarction, its presence indicated a more favorable clinical outcome and prognosis in patients with anterior infarction. Among the patients with anterior infarction the 65 patients in Group A had a higher ejection fraction (44 +/- 9% vs. 35 +/- 11%, p < 0.01), less heart failure (15% vs. 35%, p = 0.02) and a lower in-hospital mortality rate (0% vs. 8%, p = 0.04) than did the 37 patients from Group B.


CONCLUSIONS
Additional ST elevation early during thrombolytic therapy in patients with anterior infarction suggests a favorable clinical outcome and thus may be indicative of successful reperfusion.
Shechter
M
M
Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel.
Rabinowitz
B
B
Beker
B
B
Motro
M
M
Barbash
G
G
Kaplinsky
E
E
Hod
H
H
D000368:Aged; D003402:Creatine Kinase / Q000097:blood; D004452:Echocardiography; D004562:Electrocardiography / Q000592:standards*; D005260:Female; D015637:Gated Blood-Pool Imaging; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007527:Isoenzymes; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015425:Myocardial Reperfusion / Q000592:standards; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D015912:Thrombolytic Therapy / Q000379:methods / Q000592:standards*; D013997:Time Factors; D016896:Treatment Outcome
D007527:Isoenzymes; D003402:Creatine Kinase