Early recurrence of ST-segment elevation in patients with initial reperfusion during thrombolytic therapy: impact on in-hospital reinfarction and long-term vessel patency.
OBJECTIVE
To investigate the frequency and prognostic impact of early recurrent ST-segment elevation after initial ST-segment resolution in patients with acute myocardial infarction who had been treated with intravenous thrombolysis.


METHODS
Eighty-one patients with acute myocardial infarction underwent 24 h Holter monitoring of the infarct-related ST-segment elevation, at the initiation of thrombolytic therapy. Angiography was performed in 88% of the patients 9 +/- 4 days after infarction.


RESULTS
Resolution of the ST-segment elevation during the first 4 h, suggestive of early reperfusion, occurred in 67 (83%) patients (group 1). Of these, 31 (46%) had subsequent re-elevations (group 1a), 26 during the first 4 h, and 20 later. Thirty-six (54%) patients had no recurrence of the ST-segment elevation (group 1b). During follow-up, patients in group 1a experienced more in-hospital reinfarctions (26 versus 6%, P = 0.04) and had a higher rate of occluded infarct-related vessels at angiography than patients in group 1b (40 versus 17%, P = 0.01).


CONCLUSIONS
During the first 24 h after initiation of thrombolytic therapy, recurrences of ST-segment elevation are frequent in myocardial infarction patients with ECG signs of an initially reperfused infarct-related artery. Recurrence of ST-segment elevation indicates a higher risk of reinfarction during hospitalization and of long-term occlusion of the infarct artery.
Department of Cardiopulmonology, Klinikum Steglitz, Free University of Berlin, Germany.
R
R
Dissmann
R
R
Schröder
T
T
Brüggemann
H
H
Völler
H
H
Schäfer
T
T
Linderer
D000368:Aged; D003331:Coronary Vessels / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy; D015425:Myocardial Reperfusion; D011379:Prognosis; D012008:Recurrence; D012306:Risk; D015912:Thrombolytic Therapy; D014654:Vascular Patency