Sudden increase of the ST segment elevation at time of reperfusion predicts extensive infarcts in patients with intravenous thrombolysis.
Within 4 hours from the onset of symptoms in 61 patients with myocardial infarction and intravenous thrombolysis, ST segment elevation and creatine phosphokinase (CK) were measured every 15 minutes. Because of a premature enzyme rise, 42 patients (69%) were reperfused early (group 1). Immediately following reperfusion, eight of them (13%, group 1a) showed a marked increase of the ST elevation, in six of whom it was associated with clearly intensified chest pain. These patients exhibited a much steeper enzyme release and developed a larger enzymatic infarct size than patients (group 1b) without an additional transient ST elevation at reperfusion (CK peak 5.1 +/- 1.6 vs 9.8 +/- 4.2 hours after the start of thrombolysis; CK release 48 +/- 22 vs 19 +/- 18 IU/ml x hours, both p < 0.005). At angiography 11 days later, left ventricular function was significantly worse in group 1a than in group 1b (regional dyssynergic area 51 +/- 24 vs 21 +/- 18, global ejection fraction 39 +/- 14 vs 58 +/- 11; both p < 0.0005). During intravenous thrombolysis in acute myocardial infarction, some patients show a marked transient increase of the ST segment elevation at reperfusion. Their enzyme rise is very rapid and suggests a special reperfusion pattern. Most of these patients suffered large infarcts.
Dissmann
R
R
Department of Cardiopulmology, Klinikum Steglitz, Free University Berlin, Germany.
Linderer
T
T
Goerke
M
M
von Ameln
H
H
Rennhak
U
U
Schröder
R
R
D000328:Adult; D000368:Aged; D016255:Anistreplase / Q000008:administration & dosage*; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D004796:Clinical Enzyme Tests / Q000706:statistics & numerical data; D017023:Coronary Angiography; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004562:Electrocardiography / Q000187:drug effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D011379:Prognosis; D013300:Streptokinase / Q000008:administration & dosage*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*
D016255:Anistreplase; D013300:Streptokinase; D014568:Urokinase-Type Plasminogen Activator