Is ST segment re-elevation associated with reperfusion an indicator of marked myocardial damage after thrombolysis?
OBJECTIVE
The significance of ST segment re-elevation at reperfusion by thrombolysis was evaluated.


BACKGROUND
The significance of ST re-elevation has not been studied. Hence, we evaluated whether ST re-elevation is an indicator of marked myocardial necrosis after reperfusion.


METHODS
Twelve-lead electrocardiograms were recorded serially, before thrombolysis and immediately after each coronary angiographic procedure during thrombolysis.


RESULTS
In 32 patients with acute myocardial infarction, 15 showed transient ST re-elevation at reperfusion (group 1) and 17 showed reduction (group 2). Peak creatine kinase (CK) and CK-MB isoenzyme activity levels were significantly higher in group 1 than in group 2. Twelve patients in group 1 had strongly positive findings on early technetium-99m pyrophosphate scintigraphy, compared with one patient in group 2 (p < 0.001). The regional ejection fraction did not increase from the acute phase to the chronic phase in group 1. The ST deviation before thrombolysis was significantly greater in group 1 than in group 2 (p < 0.001). All 14 patients in group 1 showed Thrombolysis in Myocardial Infarction (TIMI) grade 0 flow and 12 of these patients did not have good collateral flow before thrombolysis.


CONCLUSIONS
These data suggest that 1) ST re-elevation at reperfusion is a sign of limited myocardial salvage by thrombolysis, and 2) high ST elevation and TIMI grade 0 flow without good collateral flow before thrombolysis may be predictive variables for marked myocardial necrosis after reperfusion.
Kondo
M
M
Division of Cardiology, Shimada Municipal Hospital, Shizuoka, Japan.
Tamura
K
K
Tanio
H
H
Shimono
Y
Y
D000368:Aged; D000704:Analysis of Variance; D004796:Clinical Enzyme Tests; D017023:Coronary Angiography; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography / Q000706:statistics & numerical data; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis* / Q000453:epidemiology; D011877:Radionuclide Imaging; D016698:Technetium Tc 99m Pyrophosphate; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D013997:Time Factors; D016277:Ventricular Function, Left
D007527:Isoenzymes; D016698:Technetium Tc 99m Pyrophosphate; D003402:Creatine Kinase