[Detection of early reperfusion and prediction of left ventricular damage from the course of increased ST values in acute myocardial infarct with thrombolysis].
In 60 patients with acute myocardial infarction (pain < or = 4 h), we examined the value of ST segment monitoring in predicting early reperfusion, resulting left ventricular damage, and complications during hospitalization. Two criteria were determined by observation of the ST segment elevation during the first 4 h following initiation of thrombolysis. Early reperfusion was assessed by an early increase of the creatine phosphokinase (CK) with measurements taken in 15-min intervals. Cardiac catheterization was performed on days 11 +/- 5. According to the CK measurements, a reduction of the ST elevation > or = 50% within 1 h of serial ECG follow-up (ST criterion A) was the best indicator of early reperfusion (sensitivity 84%, specificity 80%, positive predictive value 93%, negative predictive value 67%). Simple comparison of the ST segment in the initial ECG and an ECG recorded 3 h later (ST criterion B) was less accurate according to the detection of early reperfusion (sensitivity 68%, specitivity 93%, positive predictive value 97%, negative predictive value 50%). However, contrary to ST criterion A, criterion B was useful in predicting subsequent left ventricular damage. Patients with a resolution of the initial ST elevation > or = 70%/3 h showed smaller regional wall motion abnormalities (dyssynergic area 21.3 +/- 20.3 vs 33.8 +/- 18.4, p < 0.01) and a better left ventricular ejection fraction (57.7 +/- 11.6 vs 50.2 +/- 12.6, p < 0.05). Patients with early reduction of the ST elevation following either criterion experienced fewer critical events (reinfarction, reischemia, death). In conclusion, the investigated criteria are useful in assessing reperfusion of the infarcted artery following thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)
Dissmann
R
R
Abteilung für Kardiopulmologie, Klinikum Steglitz, Freie Universität Berlin.
Goerke
M
M
von Ameln
H
H
Rennhak
U
U
Schroeder
J
J
Linderer
T
T
Schröder
R
R
D016255:Anistreplase / Q000008:administration & dosage; D003326:Coronary Circulation / Q000187:drug effects* / Q000502:physiology; D003402:Creatine Kinase / Q000097:blood; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis* / Q000503:physiopathology; D012008:Recurrence; D013300:Streptokinase / Q000008:administration & dosage; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage; D016277:Ventricular Function, Left / Q000187:drug effects* / Q000502:physiology
D016255:Anistreplase; D003402:Creatine Kinase; D013300:Streptokinase; D014568:Urokinase-Type Plasminogen Activator
Erkennung der frühen Reperfusion und Vorhersage der linksventrikulären Schädigung aus dem Verlauf der ST-Strecken-Hebung beim akuten Myokardinfarkt mit Thrombolyse.